Time Series Analysis of Trends in Malaria Cases and Deaths at Hospitals and the Effect of Antimalarial Interventions, 2001-2011, Ethiopia
Time Series Analysis of Trends in Malaria Cases and Deaths at Hospitals and the Effect of Antimalarial Interventions, 2001-2011, Ethiopia
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DOI：
10.1371/journal.pone.0106359
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发表时间：
2014-11-18
期刊：
影响因子：
3.7
通讯作者：
Coosemans, Marc
中科院分区：
文献类型：
--
作者：
Aregawi, Maru;Lynch, Michael;Coosemans, Marc
背景：埃塞俄比亚政府及其合作伙伴自 2004 年以来部署了基于青蒿素的联合疗法 (ACT)，自 2005 年以来部署了长效杀虫蚊帐 (LLIN)。2001-2011 年期间，对疟疾传播地区的医院进行了疟疾干预措施以及疟疾病例和死亡趋势的评估。方法：使用区域 LLIN 分布记录来估计受 LLIN 保护的高危人群比例。审查医院记录以估计 ACT 的可用性。对疟疾风险地区 41 家医院的数据进行时间序列分析，以评估干预前（2001-2005 年）和干预后（2006-2011 年）期间疟疾病例和死亡的趋势。研究结果：2011 年，受 LLIN 潜在保护的高危人群比例增加至 51%。2011 年，备有 ACT 的设施比例超过 87%。 2006-2011。在所有年龄段中，与干预前趋势预测的水平相比，2011 年确诊的疟疾病例下降了 66%（95% 置信区间 [CI]，44-79%），SPR 下降了 37%（CI，20%-51%）。在 5 岁以下儿童中，因疟疾入院和死亡人数分别下降了 81%（CI，47%-94%）和 73%（CI，48%-86%）。趋势线的最佳断点出现在 2006 年 1 月至 6 月之间，与疟疾干预措施的时间一致。同期，非疟疾病例和死亡人数有所增加或保持不变，进行的疟疾诊断检测数量反映了疟疾病例的下降，降雨量保持在有利于疟疾传播的水平。结论：随着疟疾干预措施的扩大，2006年至2011年间，埃塞俄比亚医院的疟疾病例和死亡人数大幅下降。这一下降不能用医院就诊次数、疟疾诊断检测或降雨量的变化来解释。然而，考虑到埃塞俄比亚不同疟疾传播的历史，需要更多数据来确定
Background: The Government of Ethiopia and its partners have deployed artemisinin-based combination therapies (ACT) since 2004 and long-lasting insecticidal nets (LLINs) since 2005. Malaria interventions and trends in malaria cases and deaths were assessed at hospitals in malaria transmission areas during 2001-2011.Methods: Regional LLINs distribution records were used to estimate the proportion of the population-at-risk protected by LLINs. Hospital records were reviewed to estimate ACT availability. Time-series analysis was applied to data from 41 hospitals in malaria risk areas to assess trends of malaria cases and deaths during pre-intervention (2001-2005) and post-interventions (2006-2011) periods.Findings: The proportion of the population-at-risk potentially protected by LLINs increased to 51% in 2011. The proportion of facilities with ACTs in stock exceeded 87% during 2006-2011. Among all ages, confirmed malaria cases in 2011 declined by 66% (95% confidence interval [CI], 44-79%) and SPR by 37% (CI, 20%-51%) compared to the level predicted by preintervention trends. In children under 5 years of age, malaria admissions and deaths fell by 81% (CI, 47%-94%) and 73% (CI, 48%-86%) respectively. Optimal breakpoint of the trendlines occurred between January and June 2006, consistent with the timing of malaria interventions. Over the same period, non-malaria cases and deaths either increased or remained unchanged, the number of malaria diagnostic tests performed reflected the decline in malaria cases, and rainfall remained at levels supportive of malaria transmission.Conclusions: Malaria cases and deaths in Ethiopian hospitals decreased substantially during 2006-2011 in conjunction with scale-up of malaria interventions. The decrease could not be accounted for by changes in hospital visits, malaria diagnostic testing or rainfall. However, given the history of variable malaria transmission in Ethiopia, more data would be required to