Community-based environmental management for malaria control: evidence from a small-scale intervention in Dar es Salaam, Tanzania.
Community-based environmental management for malaria control: evidence from a small-scale intervention in Dar es Salaam, Tanzania.
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DOI：
10.1186/1475-2875-8-57
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发表时间：
2009-04-08
期刊：
影响因子：
3
通讯作者：
Mkude S
中科院分区：
文献类型：
--
作者：
Castro MC;Tsuruta A;Kanamori S;Kannady K;Mkude S
从历史上看，环境管理在控制疟疾和全面改善卫生条件方面取得了重要成就。然而，目前的执行通常被认为不具有成本效益。2005年至2007年期间，在达累斯萨拉姆开展了以社区为基础的疟疾控制环境管理。在社区敏化后，对两条排水沟进行了清洁和维护。本文评估了干预措施对社区意识、疟疾感染流行和下水道按蚊幼虫存在的影响。在清洁排水沟附近的社区进行了一项调查；为了进行比较，还调查了两个使用杀幼虫剂的排水沟和两个未进行干预的排水沟附近的社区。还使用了城市疟疾控制规划例行收集的数据。通过比较均值、优势比（OR）、逻辑回归和移动平均计算的时间趋势来评估不同的影响。在敏感社区，个人对健康风险和干预目标的认识明显更高。与清洁前相比，清洁后干预社区的疟疾感染几率降低（OR = 0.12, 95% CI 0.05-0.3, p < 0.001）。清洁后，未进行干预的社区感染风险高于进行干预的社区（OR = 1.7, 95% CI 1.1-2.4, p = 0.0069）。在最初的清洁18个月后，由于持续的维护工作，其中一个排水管仍然是干净的（它不含废物，水以正常速度流动）。对该排水沟中含有蛹和（或）按蚊幼虫的水体生境百分比的三个月移动平均值表明，幼虫密度有所下降。另一方面，缺乏适当的资源和地方承诺限制了成功。虽然环境管理历来是由专制/殖民政权或工业/公司协调的，但如果遵守以下四个条件，作为民主政府控制疟疾的综合病媒管理框架的一部分，环境管理的成功实施是可能的：政治意愿和承诺、社区的敏感认识和参与、为初步清洁和结构维修提供财政资源以及部门间合作。这种努力不仅有望减少疟疾的传播，而且有可能赋予社区权力，改善健康和环境条件，并最终有助于减轻贫穷和可持续发展。
Historically, environmental management has brought important achievements in malaria control and overall improvements of health conditions. Currently, however, implementation is often considered not to be cost-effective. A community-based environmental management for malaria control was conducted in Dar es Salaam between 2005 and 2007. After community sensitization, two drains were cleaned followed by maintenance. This paper assessed the impact of the intervention on community awareness, prevalence of malaria infection, and Anopheles larval presence in drains. A survey was conducted in neighbourhoods adjacent to cleaned drains; for comparison, neighbourhoods adjacent to two drains treated with larvicides and two drains under no intervention were also surveyed. Data routinely collected by the Urban Malaria Control Programme were also used. Diverse impacts were evaluated through comparison of means, odds ratios (OR), logistic regression, and time trends calculated by moving averages. Individual awareness of health risks and intervention goals were significantly higher among sensitized neighbourhoods. A reduction in the odds of malaria infection during the post-cleaning period in intervention neighbourhoods was observed when compared to the pre-cleaning period (OR = 0.12, 95% CI 0.05–0.3, p < 0.001). During the post-cleaning period, a higher risk of infection (OR = 1.7, 95% CI 1.1–2.4, p = 0.0069) was observed in neighbourhoods under no intervention compared to intervention ones. Eighteen months after the initial cleaning, one of the drains was still clean due to continued maintenance efforts (it contained no waste materials and the water was flowing at normal velocity). A three-month moving average of the percentage of water habitats in that drain containing pupae and/or Anopheles larvae indicated a decline in larval density. In the other drain, lack of proper resources and local commitment limited success. Although environmental management was historically coordinated by authoritarian/colonial regimes or by industries/corporations, its successful implementation as part of an integrated vector management framework for malaria control under democratic governments can be possible if four conditions are observed: political will and commitment, community sensitization and participation, provision of financial resources for initial cleaning and structural repairs, and inter-sectoral collaboration. Such effort not only is expected to reduce malaria transmission, but has the potential to empower communities, improve health and environmental conditions, and ultimately contribute to poverty alleviation and sustainable development.
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DOI：
10.1016/0169-4758(87)90204-3
发表时间：
1987-05-01
期刊：
PARASITOLOGY TODAY
影响因子：
--
作者：
BOS, R;MILLS, A
通讯作者：
MILLS, A
DOI：
10.4269/ajtmh.2006.74.972
发表时间：
2006-06-01
影响因子：
3.3
作者：
Kleinschmidt, I;Sharp, B;Carter, J
通讯作者：
Carter, J
影响因子：
2.7
作者：
Konradsen, F;van der Hoek, W;Boelee, E
通讯作者：
Boelee, E
影响因子：
168.9
作者：
Goodman, CA;Coleman, PG;Mills, AJ
通讯作者：
Mills, AJ
DOI：
10.4269/ajtmh.2004.71.224
发表时间：
2004-08-01
影响因子：
3.3
作者：
De Savigny, D;Binka, F
通讯作者：
Binka, F