The use of insecticide-treated nets for reducing malaria morbidity among children aged 6-59 months, in an area of high malaria transmission in central Cote d'Ivoire
The use of insecticide-treated nets for reducing malaria morbidity among children aged 6-59 months, in an area of high malaria transmission in central Cote d'Ivoire
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DOI：
10.1186/1756-3305-3-91
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发表时间：
2010-09-22
影响因子：
3.2
通讯作者：
Tschannen, Andres B.
中科院分区：
文献类型：
--
作者：
Koudou, Benjamin G.;Ghattas, Hala;Tschannen, Andres B.
背景：长效驱虫蚊帐是控制疟疾的重要工具。在撒哈拉以南非洲，人们非常关注长效驱虫蚊帐对降低疟原虫感染率和临床确诊疟疾病例的影响。我们在科特迪瓦中部图莫迪地区的五个村庄进行了一项流行病学研究，以调查长效驱虫蚊帐是否对疟原虫流行率和临床确诊疟疾病例的比例产生影响。从2007年4月至2008年11月，在研究村庄实施了一项以社区为基础的疟疾控制方案，其中包括大规模分发长效驱虫蚊帐，以及在社区内开展培训和宣传活动。我们从2007年4月开始，每6个月重复一次，通过一系列横断面调查，确定该方案对6-59个月儿童的疟原虫流行率、临床确诊疟疾病例和高寄生虫血症率比例的影响。我们观察到从2007年4月到2008年4月恶性疟原虫平均患病率显著下降（p = 0.029）。2007年11月至2008年11月观察到相反的趋势，恶性疟原虫患病率显著增加（p = 0.003）。2007年4月至2008年4月期间，疟疾临床病例比例显著下降（p < 0.001），2007年11月至2008年11月（p = 0.001）.结论：大规模分发长效驱虫蚊帐，同时开展培训和宣传活动，在项目实施的第一年，疟疾在幼儿中的流行率显著降低，而在整个18个月的项目期间，疟疾的临床发病率总体下降。社区睡在蚊帐下的积极性下降，也许沿着疟疾传播模式的变化，可能解释了2007年11月至2008年11月期间观察到的疟原虫流行率上升的原因。
Background: Long-lasting insecticidal nets (LLINs) are an important tool for controlling malaria. Much attention has been devoted to determine both the effect of LLINs on the reduction of Plasmodium infection rate and on clinically-confirmed malaria cases in sub-Saharan Africa. We carried out an epidemiological study to investigate whether LLINs impact on Plasmodium prevalence rate and the proportion of clinically-confirmed malaria cases, in five villages in the district of Toumodi, central Cote d'Ivoire.Methods: From April 2007 to November 2008, a community-based malaria control programme was implemented in the study villages, which involved large-scale distribution of LLINs, and training and sensitization activities within the community. We determined the effect of this programme on Plasmodium prevalence rate, clinically-confirmed malaria cases and proportion of high parasitaemia rates in children aged 6-59 months through a series of cross-sectional surveys starting in April 2007 and repeated once every 6 months.Results: We observed a significant decrease in the mean P. falciparum prevalence rate from April 2007 to April 2008 (p = 0.029). An opposite trend was observed from November 2007 to November 2008 when P. falciparum prevalence rate increased significantly (p = 0.003). Highly significant decreases in the proportions of clinical malaria cases were observed between April 2007 and April 2008 (p < 0.001), and between November 2007 and November 2008 (p = 0.001).Conclusions: Large-scale distribution of LLINs, accompanied by training and sensitization activities, significantly reduced Plasmodium prevalence rates among young children in the first year of the project, whereas overall clinical malaria rates dropped over the entire 18-month project period. A decrease in community motivation to sleep under bed nets, perhaps along with changing patterns of malaria transmission, might explain the observed increase in the Plasmodium prevalence rate between November 2007 and November 2008.