Malaria in the highlands of Madagascar after five years of indoor house spraying of DDT
Malaria in the highlands of Madagascar after five years of indoor house spraying of DDT
复制标题
DOI：
10.1016/s0035-9203(01)90317-7
复制
发表时间：
2001-01-01
影响因子：
2.2
通讯作者：
Boisier, P
中科院分区：
文献类型：
--
作者：
Jambou, R;Ranaivo, L;Boisier, P
马达加斯加的中部地区是一片广阔的高地（海拔700-2000米）。据卫生部长说，自1985- 1990年最后一次流行以来，疟疾传播在这里重新出现，造成4万人死亡。为了防治该区域的主要疟疾病媒，狐按蚊，1993年12月至1998年1月在海拔1000-1500米的大多数农村地区进行了每年室内喷洒滴滴涕的方案。然后在高原学校进行了一项寄生虫学和血清学研究，以评价该方案的影响，并建立了一个关于该地区的数据库。采用整群抽样方法进行了2次独立选择（130个站点中的一个，40个站点中的另一个）。在研究期间，对13462名学童进行了检查，其中71%生活在喷洒过农药的村庄。寄生虫在学龄儿童中的患病率随着海拔的增加而下降，从700-900米的11%下降到100 - 1500米的0.4%。在1500 m以下，喷施对寄生虫流行率的影响非常明显（1000 m以下平均下降20% ~ 2.7%，1000 ~ 1500 m不喷施平均下降4.5% ~ 0.8%）。对数据的地理分析表明，边缘地区仍然是受疟疾影响最严重的地区（特别是在喷洒区之外），并且在1000-1500米的地方持续存在小范围传播，主要是在从未使用过喷洒的地区。9所学校用间接免疫荧光法在被寄生红细胞厚涂片上寻找抗疟原虫抗体。血清阳性率从22%到63%不等，这表明该寄生虫仍在该地区传播。尽管我们的数据显示，病媒控制在马达加斯加高地仍然非常成功，但可能会发生快速再感染，必须在喷洒后进行监测。为此目的，卫生部长在意大利合作组织的支持下，自1997年以来将该地区置于流行病学监测之下。此外，还建立了一个警报系统，以便及时发现流行病的来源并确定防治病媒运动的目标。我们的研究表明，为了巩固在高海拔地区取得的成果，应该在边缘地区喷洒滴滴涕来加强这一策略。
The central region of Madagascar is a vast area of highlands (altitude 700-2000 m). Malaria transmission has re-established itself here since the last epidemic of 1985-90 and has caused the deaths of 40 000 persons according to the Minister of Health. To combat the main malaria Vector in the region, Anopheles funestus, annual programmes of indoor house spraying of DDT were carried out between December 1993 and January 1998 in most rural areas at altitude 1000-1500 m. A parasitological and serological study was then conducted in the highland schools to evaluate the impact of the programme and set: up a database on the region. Using a cluster-sampling method 2 independent selections were conducted (one of 130 sites, the other of 40 sites). During the study, 13 462 schoolchildren were examined, 71% living in sprayed villages. Parasite: prevalence among schoolchildren declined as altitude increases, from 11% at: 700-900 m to 0.4% at > 1500 m. Below 1500 m, the impact of the spraying on the prevalence of the parasite was very clear (an average decrease of from 20% to 2.7% below 1000 m and of from 4.5% without spraying to 0.8% at 1000-1500 m). Geographical analysis of the data showed that the marginal regions remained the most affected by malaria (especially outside spraying zones), and persistence of pockets of transmission' at 1000-1500 m, essentially in areas where spraying has never been used. In 9 schools, anti-Plasmodium antibodies were sought by indirect immunofluorescence on thick smears of parasitized red blood cells. The seroprevalence ranged from 22% to 63%, which suggests that the parasite is still circulating in the region. Even though our data show that vector control continues to be very successful in the Madagascan highlands, rapid reinfection could occur and must be monitored following spraying. To this end, the Minister for Health, with the support of the Italian Co-operation, has placed the region under epidemiological surveillance since 1997. An alert system for the timely detection of the sources of epidemics and the targeting of the anti-vectoral campaign is also in operation. Our study suggests that this strategy should be reinforced by the spraying of DDT in the marginal zones in order to consolidate the results obtained at higher altitudes.