Rapid reduction of malaria transmission following the introduction of indoor residual spraying in previously unsprayed districts: an observational analysis of Mopti Region, Mali, in 2017.
Rapid reduction of malaria transmission following the introduction of indoor residual spraying in previously unsprayed districts: an observational analysis of Mopti Region, Mali, in 2017.
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DOI：
10.1186/s12936-020-03414-2
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发表时间：
2020-09-19
期刊：
影响因子：
3
通讯作者：
Robertson M
中科院分区：
文献类型：
--
作者：
Wagman J;Cissé I;Kone D;Fomba S;Eckert E;Mihigo J;Bankineza E;Bah M;Diallo D;Gogue C;Tynuv K;Saibu A;Richardson JH;Fornadel C;Slutsker L;Robertson M
马里国家疟疾控制计划 (NMCP) 最近在拟除虫菊酯抗药性地区（主要是塞古和库利科罗地区）使用第三代室内滞留喷洒 (IRS) 产品，成功减少了疟疾传播。 2015 年，国家调查数据显示，莫普提地区 5 岁以下 (u5) 疟疾患病率最高，为 54%，几乎是全国平均水平的两倍，尽管该地区拥有大量长效杀虫蚊帐 (LLIN) 和季节性疟疾化学预防 (SMC)。因此，2016 年，NMCP 和其他利益相关者将国税局的活动从塞古转移到莫普提。这里介绍了利用常规疟疾指标来评估这种转变的影响的一系列观察分析的结果。使用 2016 年 1 月至 2018 年 2 月期间地区卫生信息系统 2 (DHIS2) 中报告的快速诊断检测 (RDT) 确诊疟疾病例的月发病率进行了一组回顾性生态观察时间序列分析。对同一地区不同 IRS 状态（IRS 与无 IRS）的卫生机构之间的病例发病率进行了比较，以描述 2016 年和2017 年 IRS 活动，并采用双重差分法比较发病率的逐年变化，用于描述 2017 年暂停塞古 IRS 业务和在莫普提引入 IRS 业务的效果。与没有 IRS 的社区相比，在 2016 年活动后的 6 个月内，塞古地区 IRS 社区的累计病例发病率降低了 16%，莫普提地区 IRS 社区累计病例发病率降低了 31%。 2017 年活动结束后的 6 个月内，可能总共避免了超过 22,000 例疟疾病例，而这些病例本应在传播高峰月份出现。在所有当年没有 IRS 的对照卫生机构 (HF) 中，从 2016 年到 2017 年，疟疾病例发病率峰值平均下降了 22% (CI95 18–30%)。在 2017 年引入 IRS 的莫普提社区的 HF 中，峰值发病率在这些年中平均下降了 42% (CI95 31–63%)，降幅显着更大(p = 0.040) 几乎是比较 HFCA 的两倍。在塞古地区观察到相反的效果，在 2016 年运动后取消 IRS 的 HF 发病率峰值每年平均增加 106% (CI95 63-150%)，与比较无 IRS HF 相比，也存在显着的差异中的差异 (p<0.0001)。每年的 IRS 活动继续为马里中部社区的疟疾传播季节性减少做出巨大贡献，其中 IRS 活动的时间安排在季节性传播高峰之前，并使用了一种微胶囊产品，其活性成分与整个地区使用的 LLIN 上发现的活性成分属于不同类别，而且当地疟疾病媒对这种活性成分敏感。每当考虑暂停特定地区的国税局活动时，应优先考虑帮助减轻预期疟疾病例复发的策略。
The National Malaria Control Programme (NMCP) of Mali has had recent success decreasing malaria transmission using 3rd generation indoor residual spraying (IRS) products in areas with pyrethroid resistance, primarily in Ségou and Koulikoro Regions. In 2015, national survey data showed that Mopti Region had the highest under 5-year-old (u5) malaria prevalence at 54%—nearly twice the national average—despite having high access to long-lasting insecticidal nets (LLINs) and seasonal malaria chemoprevention (SMC). Accordingly, in 2016 the NMCP and other stakeholders shifted IRS activities from Ségou to Mopti. Here, the results of a series of observational analyses utilizing routine malaria indicators to evaluate the impact of this switch are presented. A set of retrospective, eco-observational time-series analyses were performed using monthly incidence rates of rapid diagnostic test (RDT)-confirmed malaria cases reported in the District Health Information System 2 (DHIS2) from January 2016 until February 2018. Comparisons of case incidence rates were made between health facility catchments from the same region that differed in IRS status (IRS vs. no-IRS) to describe the general impact of the 2016 and 2017 IRS campaigns, and a difference-in-differences approach comparing changes in incidence from year-to-year was used to describe the effect of suspending IRS operations in Ségou and introducing IRS operations in Mopti in 2017. Compared to communities with no IRS, cumulative case incidence rates in IRS communities were reduced 16% in Ségou Region during the 6 months following the 2016 campaign and 31% in Mopti Region during the 6 months following the 2017 campaign, likely averting a total of more than 22,000 cases of malaria that otherwise would have been expected during peak transmission months. Across all comparator health facilities (HFs) where there was no IRS in either year, peak malaria case incidence rates fell by an average of 22% (CI95 18–30%) from 2016 to 2017. At HFs in communities of Mopti where IRS was introduced in 2017, peak incidence fell by an average of 42% (CI95 31–63%) between these years, a significantly greater decrease (p = 0.040) almost double what was seen in the comparator HFCAs. The opposite effect was observed in Ségou Region, where peak incidence at those HFs where IRS was withdrawn after the 2016 campaign increased by an average of 106% (CI95 63–150%) from year to year, also a significant difference-in-differences compared to the comparator no-IRS HFs (p < 0.0001). Annual IRS campaigns continue to make dramatic contributions to the seasonal reduction of malaria transmission in communities across central Mali, where IRS campaigns were timed in advance of peak seasonal transmission and utilized a micro-encapsulated product with an active ingredient that was of a different class than the one found on the LLINs used throughout the region and to which local malaria vectors were shown to be susceptible. Strategies to help mitigate the resurgence of malaria cases that can be expected should be prioritized whenever the suspension of IRS activities in a particular region is considered.
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