A refined estimate of the malaria burden in Niger.
A refined estimate of the malaria burden in Niger.
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DOI：
10.1186/1475-2875-11-89
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发表时间：
2012-03-27
期刊：
影响因子：
3
通讯作者：
Fandeur T
中科院分区：
文献类型：
--
作者：
Doudou MH;Mahamadou A;Ouba I;Lazoumar R;Boubacar B;Arzika I;Zamanka H;Ibrahim ML;Labbo R;Maiguizo S;Girond F;Guillebaud J;Maazou A;Fandeur T
近年来，尼日尔卫生当局实施了若干疟疾预防和控制方案。这些干预措施大体上遵循世卫组织的指导方针和国际建议，并基于在非洲其他地区被证明成功的干预措施。大多数绩效指标令人满意，但矛盾的是，尽管动员了大量人力和财政资源，但尼日尔的防治疟疾方案似乎停滞不前，因为它尚未使疟疾负担出现预期的大幅下降。事实上，在过去十年中，国家卫生信息系统报告的疟疾病例数量实际上增加了五倍，从2000年的约60万例增加到2010年的约300万例。国家报告系统的弱点之一是，疟疾病例的记录仍然基于推定的诊断方法，这种方法高估了疟疾发病率。开展了一项广泛的全国调查，通过显微镜和RDT测试来确定在保健机构就诊的疑似疟疾患者实际患有这种疾病的发烧患者的比例，以此作为评估这一问题的严重性和更好地估计尼日尔疟疾发病率的手段。这项研究总共包括12,576名发烧患者；在传播率较高的雨季，57%的载玻片疟疾寄生虫呈阳性，在传播率较低的旱季，9%的载玻片呈阳性。用快速诊断检测取代镜检方法导致确诊率更低，只有42%的病例在雨季检测呈阳性，在旱季检测呈阳性的病例占4%。单纯发热的预测价值很低，特异性和敏感性都很低。这些数据突出表明，绝对有必要通过生物诊断方法确认所有报告的疟疾病例，提高监测和评估过程中使用的疟疾指标的准确性，并改善尼日尔较偏远地区的病人护理。这个国家横跨大范围的纬度，导致存在三个主要的生物气候带，决定了病媒的分布和地方性。这项调查表明，尼日尔各卫生中心报告的推定疟疾病例数量被大大高估。这些结果突出表明，由于单纯发热性疾病患者对疟疾的过度诊断，在描述尼日尔的疟疾情况和疾病风险方面存在不足。他们指出，必须通过生物诊断方法确认所有疑似疟疾病例，并需要更有效地考虑地理限制，改进疟疾控制，并使诊断方法的选择适应有关地区的流行病学情况。因此，病例确认还需要通过培训保健工作人员、引入质量控制、加强对综合保健中心的监督、实施良好的临床做法以及全面优化现有诊断方法的使用来改变行为。
The health authorities of Niger have implemented several malaria prevention and control programmes in recent years. These interventions broadly follow WHO guidelines and international recommendations and are based on interventions that have proved successful in other parts of Africa. Most performance indicators are satisfactory but, paradoxically, despite the mobilization of considerable human and financial resources, the malaria-fighting programme in Niger seems to have stalled, as it has not yet yielded the expected significant decrease in malaria burden. Indeed, the number of malaria cases reported by the National Health Information System has actually increased by a factor of five over the last decade, from about 600,000 in 2000 to about 3,000,000 in 2010. One of the weaknesses of the national reporting system is that the recording of malaria cases is still based on a presumptive diagnosis approach, which overestimates malaria incidence. An extensive nationwide survey was carried out to determine by microscopy and RDT testing, the proportion of febrile patients consulting at health facilities for suspected malaria actually suffering from the disease, as a means of assessing the magnitude of this problem and obtaining a better estimate of malaria morbidity in Niger. In total, 12,576 febrile patients were included in this study; 57% of the slides analysed were positive for the malaria parasite during the rainy season, when transmission rates are high, and 9% of the slides analysed were positive during the dry season, when transmission rates are lower. The replacement of microscopy methods by rapid diagnostic tests resulted in an even lower rate of confirmation, with only 42% of cases testing positive during the rainy season, and 4% during the dry season. Fever alone has a low predictive value, with a low specificity and sensitivity. These data highlight the absolute necessity of confirming all reported malaria cases by biological diagnosis methods, to increase the accuracy of the malaria indicators used in monitoring and evaluation processes and to improve patient care in the more remote areas of Niger. This country extends over a large range of latitudes, resulting in the existence of three major bioclimatic zones determining vector distribution and endemicity. This survey showed that the number of cases of presumed malaria reported in health centres in Niger is largely overestimated. The results highlight inadequacies in the description of the malaria situation and disease risk in Niger, due to the over-diagnosis of malaria in patients with simple febrile illness. They point out the necessity of confirming all cases of suspected malaria by biological diagnosis methods and the need to take geographic constraints into account more effectively, to improve malaria control and to adapt the choice of diagnostic method to the epidemiological situation in the area concerned. Case confirmation will thus also require a change in behaviour, through the training of healthcare staff, the introduction of quality control, greater supervision of the integrated health centres, the implementation of good clinical practice and a general optimization of the use of available diagnostic methods.