Mapping Plasmodium falciparum Mortality in Africa between 1990 and 2015.
Mapping Plasmodium falciparum Mortality in Africa between 1990 and 2015.
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DOI：
10.1056/nejmoa1606701
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发表时间：
2016-12-22
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影响因子：
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通讯作者：
Lim SS
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作者：
Gething PW;Casey DC;Weiss DJ;Bisanzio D;Bhatt S;Cameron E;Battle KE;Dalrymple U;Rozier J;Rao PC;Kutz MJ;Barber RM;Huynh C;Shackelford KA;Coates MM;Nguyen G;Fraser MS;Kulikoff R;Wang H;Naghavi M;Smith DL;Murray CJ;Hay SI;Lim SS
疟疾防治工作并没有例行地从国家以下各级疟疾死亡率变化的评估中得到信息。我们结合疟疾地图集项目和全球疾病负担研究的数据，以1990年至2015年5平方公里为网格，估计撒哈拉以南非洲的疟疾死亡率。我们使用地理定位数据的时空建模框架（即，在已知的纬度和经度），疟疾的临床发病率、抗疟药物治疗的覆盖率、病死率和按年龄分列的人口分布。在过去的15年里，我们估计整个撒哈拉以南非洲地区的人口总数下降了57%，（95%不确定区间，46至65）疟疾死亡率，从12.5（95%不确定区间，8.3至17.0）每10，000人在2000年至5.4（95%不确定区间，3.4至7.9）在2015年。这导致每年疟疾死亡人数总体下降37%（95%不确定区间，36至39），从1，007，000人（95%不确定区间，666，000至1，376，000人）降至631，000人（95%不确定区间，394，000至914，000人）。5岁以下儿童疟疾死亡比例从80%以上（死亡率超过万分之25）到不到40%（死亡率低于万分之1）不等。疟疾死亡率高（>10/10，000）和驱虫蚊帐和抗疟药物覆盖率低（<50%）的地区包括尼日利亚、安哥拉和喀麦隆的大部分地区以及中非共和国、刚果、几内亚和赤道几内亚的部分地区。我们估计，在过去15年中，整个撒哈拉以南非洲地区的疟疾死亡率总体下降了57%，并确定了几个死亡率高与抗疟治疗和预防计划覆盖率低相关的国家。（由比尔和梅林达盖茨基金会和其他人资助。
Malaria control has not been routinely informed by the assessment of subnational variation in malaria deaths. We combined data from the Malaria Atlas Project and the Global Burden of Disease Study to estimate malaria mortality across sub-Saharan Africa on a grid of 5 km2 from 1990 through 2015. We estimated malaria mortality using a spatiotemporal modeling framework of geolocated data (i.e., with known latitude and longitude) on the clinical incidence of malaria, coverage of antimalarial drug treatment, case fatality rate, and population distribution according to age. Across sub-Saharan Africa during the past 15 years, we estimated that there was an overall decrease of 57% (95% uncertainty interval, 46 to 65) in the rate of malaria deaths, from 12.5 (95% uncertainty interval, 8.3 to 17.0) per 10,000 population in 2000 to 5.4 (95% uncertainty interval, 3.4 to 7.9) in 2015. This led to an overall decrease of 37% (95% uncertainty interval, 36 to 39) in the number of malaria deaths annually, from 1,007,000 (95% uncertainty interval, 666,000 to 1,376,000) to 631,000 (95% uncertainty interval, 394,000 to 914,000). The share of malaria deaths among children younger than 5 years of age ranged from more than 80% at a rate of death of more than 25 per 10,000 to less than 40% at rates below 1 per 10,000. Areas with high malaria mortality (>10 per 10,000) and low coverage (<50%) of insecticide-treated bed nets and antimalarial drugs included much of Nigeria, Angola, and Cameroon and parts of the Central African Republic, Congo, Guinea, and Equatorial Guinea. We estimated that there was an overall decrease of 57% in the rate of death from malaria across sub-Saharan Africa over the past 15 years and identified several countries in which high rates of death were associated with low coverage of antimalarial treatment and prevention programs. (Funded by the Bill and Melinda Gates Foundation and others.)