Malaria morbidity and pyrethroid resistance after the introduction of insecticide-treated bednets and artemisinin-based combination therapies: a longitudinal study
Malaria morbidity and pyrethroid resistance after the introduction of insecticide-treated bednets and artemisinin-based combination therapies: a longitudinal study
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DOI：
10.1016/s1473-3099(11)70194-3
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发表时间：
2011-12-01
影响因子：
56.3
通讯作者：
Sokhna, Cheikh
中科院分区：
文献类型：
--
作者：
Trape, Jean-Francois;Tall, Adama;Sokhna, Cheikh
背景在分发经杀虫剂处理的蚊帐和使用以青蒿素为基础的联合疗法(ACTs)后，一些非洲国家报告疟疾大幅减少。我们的目的是评估这些政策对西非农村人口疟疾发病率、蚊子种群和无症状感染的影响。方法我们在2007年1月至2010年12月期间对塞内加尔Dielmo村的居民进行了纵向研究。在此期间，我们监测了居民的发烧情况，并用青蒿琥酯加阿莫地喹治疗疟疾发作。2008年7月，我们向所有村民提供了长效杀虫剂(溴氰菊酯)处理的蚊帐。在整个研究期间，我们每月进行夜间蚊子采集，并通过横断面调查评估无症状携带蚊子的情况。统计分析采用负二项回归、Logistic回归和二项或Fisher精确检验，在17858人月的随访中发现464例恶性疟的临床发作。2007年1月至2008年7月，疟疾发病密度平均为每百人月5.45(95%可信区间4.90~6.05)。发病密度在2008年8月至2010年8月期间下降至0.41(0.29-0.55)，但在2010年9月至12月期间回升至4.57(3.54-5.82)，即在LLIN分布后27-30个月。10岁或以上的成年人和儿童的疟疾发病率回升最高：2010年71次疟疾发作中有45次(63%)，而2007年和2008年384次中有126次(33%)(p
Background Substantial reductions in malaria have been reported in several African countries after distribution of insecticide-treated bednets and the use of artemisinin-based combination therapies (ACTs). Our aim was to assess the effect of these policies on malaria morbidity, mosquito populations, and asymptomatic infections in a west African rural population.Methods We did a longitudinal study of inhabitants of Dielmo village, Senegal, between January, 2007, and December, 2010. We monitored the inhabitants for fever during this period and we treated malaria attacks with artesunate plus amodiaquine. In July, 2008, we offered longlasting insecticide (deltamethrin)-treated nets (LLINs) to all villagers. We did monthly night collections of mosquitoes during the whole study period, and we assessed asymptomatic carriage from cross-sectional surveys. Our statistical analyses were by negative binomial regression, logistic regression, and binomial or Fisher exact test.Findings There were 464 clinical malaria attacks attributable to Plasmodium falciparum during 17 858 person-months of follow-up. The incidence density of malaria attacks averaged 5.45 (95% CI 4.90-6.05) per 100 person-months between January, 2007, and July, 2008, before the distribution of LLINs. Incidence density decreased to 0.41 (0.29-0.55) between August, 2008, and August, 2010, but increased back to 4.57 (3.54-5.82) between September and December, 2010-ie, 27-30 months after the distribution of LLINs. The rebound of malaria attacks were highest in adults and children aged 10 years or older: 45 (63%) of 71 malaria attacks recorded in 2010 compared with 126 (33%) of 384 in 2007 and 2008 (p