Epidemiology of Malaria in Malawi: Human Hosts and Parasites in Three Districts

尽管在过去的30年里，我们对疟疾生物学的理解取得了显著进步， 在撒哈拉以南非洲的大部分地区，消灭疟疾，甚至控制疟疾仍然遥遥无期。在这项提案中，我们将确定马拉维疟疾疾病和感染的负担，并利用现有最先进的科学方法进行控制和消除工作，以应用新的干预措施，针对已建立的干预措施，并快速准确地评估其影响。马拉维是一个受疟疾重创的国家，它在政策制定者和投资人之间建立了良好的合作关系，并拥有物质和科学基础设施，以支持这项申请中提出的新办法。 项目1的总体目标是描述疟疾流行病学变化的特点，以应对 控制和消除马拉维境内不同流行病学环境中的努力，并了解这种不断变化的流行病学如何影响疟疾的负担、疟疾感染的宿主以及抗疟疾药物耐药性的出现和传播(或逆转)。这些目标将通过以下三个具体目标来实现：1)评估马拉维不同生态地理区域疟疾感染和疾病的负担，并重新规划控制和消除疟疾干预措施；2)描述马拉维不同生态地理区域的寄生虫种群遗传学特征以及应对疟疾控制和消除干预措施；3)衡量抗疟疾药物政策变化对抗药性寄生虫流行的影响。这些目标将通过在布兰太尔、Thyolo和Chikwawa地区进行横断面研究、以卫生设施为基础的监测和小型但详细的队列研究来实现，以准确界定疾病和感染的负担并发现传播源。从这些来源收集的样本将进行基因组分析，目的是评估传播强度对种群基因组的影响，为马拉维开发适合现场的遗传工具，并检测新药导致的耐药性模式的变化。 政策。

Despite remarkable advances in our understanding of the biology of malaria in the last 30 years, malaria eliminafion, or even control, remains on the distant horizon in most of sub-Saharan Africa. In this proposal, we will define the burden of malaria disease and infecfion in Malawi and bring to control and elimination efforts the most advanced scientific methods available to apply new interventions, target established ones and assess their impact rapidly and accurately. Malawi is a country hit hard by malaria, it has an excellent collaborative relafionship between policy-makers and invesfigators and the physical and scientific infrastructure to support the novel approaches proposed in this application. The overall goal of Project 1 is to characterize the changing epidemiology of malaria in response to control and eliminafion efforts in diverse epidemiological setfings within Malawi, and to understand how this changing epidemiology affects the burden of malaria disease, the reservoir of malaria infection, and the emergence and spread (or reversal) of resistance to anfimalarial drugs. These goals will be accomplished through the following three specific aims: 1) to evaluate the burden of malaria infecfion and disease in diverse eco-geographic regions of Malawi and in relafion to control and eliminafion intervenfions, 2) to characterize the parasite population genetics in diverse eco-geographic regions of Malawi and in response to malaria control and elimination interventions and 3) to measure the effect of changes in antimalarial drug policy on the prevalence of drug-resistant parasites. These aims will be accomplished through crosssectional studies, health facility-based surveillance and small but detailed cohort studies in Blantyre, Thyolo and Chikwawa districts to accurately define the burden of disease and infection and detect sources of transmission. Specimens collected from these sources will undergo genomic analysis for the purposes of assessing the effect of transmission intensity on population genefics, the development of field-appropriate genetic tools for Malawi and for detecting changes in drug-resistance patterns as a result of new drug policies.