Increasing malaria hospital admissions in Uganda between 1999 and 2009
Increasing malaria hospital admissions in Uganda between 1999 and 2009
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DOI：
10.1186/1741-7015-9-37
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发表时间：
2011-04-13
期刊：
影响因子：
9.3
通讯作者：
Snow, Robert W.
中科院分区：
文献类型：
--
作者：
Okiro, Emelda A.;Bitira, David;Snow, Robert W.
背景：非洲一些地区正在经历疟疾的转变，部分原因是国际捐助者的支持和干预覆盖面扩大。观察到疟疾发病率下降的地区的主要特点是基线传播强度相对较低，干预措施迅速扩大。不太好的描述是不断变化的模式，疟疾负担的高寄生虫传播和控制和治疗access.Methods增长缓慢的地区：乌干达是一个国家，主要特点是激烈的，常年疟疾传播。从1999年1月至2009年12月的11年中，回顾性地收集了乌干达5家医院及其集水区的每月儿科入院数据。根据确定的集水区内人口密度变化调整的疟疾入院率在三个时期内进行了计算，这三个时期对应于干预覆盖率数据存在和不同治疗和预防政策运作的时期。开发了时间序列模型，调整了降雨量和医院使用的变化，以检查132个月内疟疾住院的变化。时间变化的因素，可能解释疾病发病率的变化进行了定性检查顺序为每个医院的设置和医院settingsResults：在四个五个网站有一个显着增加疟疾入院率之间的比较。时间序列模型的结果表明，四家医院的平均疟疾入院率逐月显著增加（趋势P < 0.001）。在所有医院，疟疾入院人数从1999年的47%增加到350%。观察到的变化干预覆盖率内的集水区的每家医院的变化显示，在2000年到2009年的33%，但伴随着增加获得国家推荐的药物在只有两个五个医院areas studied.Conclusions：疟疾疾病负担下降在非洲的一些地区是不是一个普遍现象在整个非洲大陆。尽管减少感染和疾病措施的覆盖面略有增加，但没有重大巧合，增加获得有效药物治疗疾病的机会可能不会导致非洲高传播地区的疾病负担大幅减少。需要从更广泛的疟疾背景中获得更多数据，以真实地跟踪非洲扩大干预覆盖范围的影响进展情况。
Background: Some areas of Africa are witnessing a malaria transition, in part due to escalated international donor support and intervention coverage. Areas where declining malaria rates have been observed are largely characterized by relatively low baseline transmission intensity and rapid scaling of interventions. Less well described are changing patterns of malaria burden in areas of high parasite transmission and slower increases in control and treatment access.Methods: Uganda is a country predominantly characterized by intense, perennial malaria transmission. Monthly pediatric admission data from five Ugandan hospitals and their catchments have been assembled retrospectively across 11 years from January 1999 to December 2009. Malaria admission rates adjusted for changes in population density within defined catchment areas were computed across three time periods that correspond to periods where intervention coverage data exist and different treatment and prevention policies were operational. Time series models were developed adjusting for variations in rainfall and hospital use to examine changes in malaria hospitalization over 132 months. The temporal changes in factors that might explain changes in disease incidence were qualitatively examined sequentially for each hospital setting and compared between hospital settingsResults: In four out of five sites there was a significant increase in malaria admission rates. Results from time series models indicate a significant month-to-month increase in the mean malaria admission rates at four hospitals (trend P < 0.001). At all hospitals malaria admissions had increased from 1999 by 47% to 350%. Observed changes in intervention coverage within the catchments of each hospital showed a change in insecticide-treated net coverage from < 1% in 2000 to 33% by 2009 but accompanied by increases in access to nationally recommended drugs at only two of the five hospital areas studied.Conclusions: The declining malaria disease burden in some parts of Africa is not a universal phenomena across the continent. Despite moderate increases in the coverage of measures to reduce infection and disease without significant coincidental increasing access to effective medicines to treat disease may not lead to severe disease burden reductions in high transmission areas of Africa. More data is needed from a wider range of malaria settings to provide an honest tracking progress of the impact of scaled intervention coverage in Africa.