Long-term impact of the World Bank Loan Project for schistosomiasis control: a comparison of the spatial distribution of schistosomiasis risk in China.
Long-term impact of the World Bank Loan Project for schistosomiasis control: a comparison of the spatial distribution of schistosomiasis risk in China.
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世界银行血吸虫病防治贷款项目的长期影响：中国血吸虫病风险空间分布比较
DOI：
10.1371/journal.pntd.0001620
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发表时间：
2012
影响因子：
3.8
通讯作者：
Jiang Q
中科院分区：
文献类型：
--
作者：
Zhang Z;Zhu R;Ward MP;Xu W;Zhang L;Guo J;Zhao F;Jiang Q
1992年至2001年实施了中国血吸虫病世行贷款项目。它的短期影响已从非空间角度进行了评估，但其长期影响仍不清楚，以前也没有进行过空间评估。本文利用1999-2001年和2007-2008年的全国血吸虫病风险数据集，对湖沼地区血吸虫病风险的空间分布进行了比较，以评价世界血吸虫病防治战略对中国血吸虫病负担的长期影响。在贝叶斯框架下，分别采用条件自回归先验结构和空间非结构化高斯分布建立了县级空间相关和不相关异质性的分层泊松回归模型。这项研究有两个重要的发现。WBLP战略被发现对血吸虫病控制具有良好的短期效果，但其长期效果并不理想。它成功地将血吸虫病的发病率降到了较低的水平，但由于目前流行水平较低，无法进一步为中国的血吸虫病防治做出贡献。第二个发现是，WBLP策略不能有效地压缩血吸虫病风险的空间分布。为了进一步减少血吸虫病疫区，并实现可持续控制，下一步应将重点放在中间宿主钉螺上，以阻断血吸虫病在洞庭湖和鄱阳湖周围两个受影响最严重的地区的传播。此外，在长江下游，WBLP的发病率控制战略可能需要持续一段时间，直到上游省份的钉螺得到很好的控制。由于目前血吸虫病的流行水平较低，在中国的湖泊和沼泽地区采用以化疗为基础的控制战略很难进一步降低血吸虫病的发病率。今后的血吸虫病防治策略应该是以钉螺为主的综合防治策略，以保持规划成果，可持续减轻中国地区的血吸虫病负担。日本血吸虫病是中国的一种重要疾病，已有2100多年的记载历史。1992年至2001年实施的世界银行贷款项目为中国的血吸虫病控制做出了巨大贡献。这项研究表明，WBLP战略对血吸虫病控制的长期效果并不理想。只能将血吸虫病发病率维持在较低水平，但不能进一步降低。WBLP策略不能有效地压缩血吸虫病风险的空间分布。为进一步减少血吸虫病疫区，实现可持续控制，建议下一步重点控制湖区和沼泽区的中间宿主钉螺，以切断洞庭湖和鄱阳湖周边两个血吸虫病重灾区的血吸虫病传播。而在长江下游，WBLP的发病率控制战略可能需要持续一段时间，直到上游省份的钉螺得到很好的控制。
The World Bank Loan Project (WBLP) for controlling schistosomiasis in China was implemented during 1992–2001. Its short-term impact has been assessed from non-spatial perspective, but its long-term impact remains unclear and a spatial evaluation has not previously been conducted. Here we compared the spatial distribution of schistosomiasis risk using national datasets in the lake and marshland regions from 1999–2001 and 2007–2008 to evaluate the long-term impact of WBLP strategy on China's schistosomiasis burden. A hierarchical Poisson regression model was developed in a Bayesian framework with spatially correlated and uncorrelated heterogeneities at the county-level, modeled using a conditional autoregressive prior structure and a spatially unstructured Gaussian distribution, respectively. There were two important findings from this study. The WBLP strategy was found to have a good short-term impact on schistosomiasis control, but its long-term impact was not ideal. It has successfully reduced the morbidity of schistosomiasis to a low level, but can not contribute further to China's schistosomiasis control because of the current low endemic level. A second finding is that the WBLP strategy could not effectively compress the spatial distribution of schistosomiasis risk. To achieve further reductions in schistosomiasis-affected areas, and for sustainable control, focusing on the intermediate host snail should become the next step to interrupt schistosomiasis transmission within the two most affected regions surrounding the Dongting and Poyang Lakes. Furthermore, in the lower reaches of the Yangtze River, the WBLP's morbidity control strategy may need to continue for some time until snails in the upriver provinces have been well controlled. It is difficult to further reduce morbidity due to schistosomiasis using a chemotherapy-based control strategy in the lake and marshland regions of China because of the current low endemic levels of infection. The future control strategy for schistosomiasis should instead focus on a snail-based integrated control strategy to maintain the program achievements and sustainably reduce the burden of schistosomiasis in China. Schistosomiasis japonica is an important disease in China with a documented history of more than 2,100 years. The World Bank Loan Project (WBLP) implemented during 1992–2001 contributed greatly to China's schistosomiasis control. This study shows that the long-term impact of WBLP strategy on schistosomiasis control was not ideal. It can only maintain the morbidity of schistosomiasis at a low level, but can not reduce it further. Also, the WBLP strategy could not effectively compress the spatial distribution of schistosomiasis risk. To achieve further reductions in schistosomiasis-affected areas, and for sustainable control, focusing on controlling the intermediate host snail in the lake and marshland regions was suggested to be the next step to interrupt schistosomiasis transmission within the two most affected regions surrounding the Dongting and Poyang Lakes. While in the lower reaches of the Yangtze River, the WBLP's morbidity control strategy may need to continue for some time until snails in the upriver provinces have been well controlled.
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DOI：
10.1186/1742-5573-7-3
发表时间：
2010-07-14
期刊：
Epidemiologic perspectives & innovations : EP+I
影响因子：
--
作者：
Sudat SE;Carlton EJ;Seto EY;Spear RC;Hubbard AE
通讯作者：
Hubbard AE
影响因子：
4
作者：
Tanaka, H;Tsuji, M
通讯作者：
Tsuji, M
影响因子：
1.9
作者：
Minggang, Chen;Zheng, Feng
通讯作者：
Zheng, Feng
DOI：
10.1073/pnas.0601559103
发表时间：
2006-05-02
影响因子：
11.1
作者：
Raso, G;Vounatsou, P;Utzinger, J
通讯作者：
Utzinger, J
影响因子：
9.6
作者：
Brooker S;Hay SI;Bundy DA
通讯作者：
Bundy DA