EPIDEMIOLOGY OF CLINICAL MALARIA IN WESTERN KENYA HIGHLANDS

描述（由申请人提供）：肯尼亚西部高地临床疟疾流行病学疟疾是非洲主要的公共卫生问题。估计非洲每年有100万人死于疟疾，其中大多数死亡发生在撒哈拉以南地区的5岁以下儿童。非洲高地（海拔1500米以上的地区）过去没有疟疾或疟疾非常有限，但自1980年代以来出现了周期性流行病，每年有11万多人死亡。在全球防治疟疾基金、总统疟疾倡议和其他私人基金会的支持下，2006年在肯尼亚启动了强化控制工作。这些努力包括大规模分发经杀虫剂处理的蚊帐、室内残留喷洒以及使用以青蒿素为基础的联合疗法（ACT）来治疗无并发症的疟疾。虽然这些控制措施似乎成功地降低了疟疾流行率和发病率，但由于疟疾流行率和发病率的数据往往难以或过于昂贵而难以在大范围内获得，因此没有对这些努力进行严格的监测和评估规划。虽然基于医院的数据是可用的，而且是一种廉价的数据来源，但这种数据源的可靠性存在不确定性。此外，肯尼亚西部高地地区的临床疟疾发病率仍然很高，因此正在实施强化病媒控制措施和新的抗疟疾治疗制度。本应用程序的目的是确定以医院为基础的疟疾病例数据在代表自然疟疾发病率方面的可靠性，以及这些数据在评估疟疾控制措施的影响方面的有用性，并确定正在进行密集疟疾干预的地区临床疟疾感染的风险因素。我设计了两个具体目标。第一个具体目标检验这样一种假设，即误诊、家庭治疗和寻求医院治疗的行为是代表自然疟疾发病率的医院疟疾病例数据错误的主要来源。第二个具体目标检验了这样一种假设，即个别家庭的临床疟疾感染风险可能受到生物和非生物因素以及社会经济问题的影响，这些风险因素对临床疟疾的重要性可以通过病例对照研究来确定。这项研究将回答一些重要的问题，例如基于医院的疟疾病例数据是否适合用于疟疾发病率监测和疟疾控制工作的影响评估，并将有助于在非洲加强疟疾控制的时代开发针对临床疟疾重要危险因素的新方法。

DESCRIPTION (provided by applicant): Epidemiology of Clinical Malaria in Western Kenya Highlands Malaria is a major public health problem in Africa. An estimated one million people in Africa die from malaria each year, with the majority of fatalities occurring in children under the age of 5 in areas south of the Sahara. The African highlands (areas with elevation above 1500 m above sea level), where malaria used to be absent or very limited, has experienced periodic epidemics since the 1980's, with more than 110,000 fatalities each year. With the support of Global Funds to Fight Malaria, Presidential Malaria Initiatives and other private foundations, intensive control efforts were initiated in 2006 in Kenya. These efforts included large-scale distribution of insecticide treated nets, indoor residual spraying, and the use of artemisinin- based combination therapy (ACT) to treat uncomplicated malaria. Although these control measures appear successful in reducing malaria prevalence and incidence, there is no rigorous monitoring and evaluation program for these efforts because data on malaria prevalence and incidence are often difficult or too expensive to obtain on a large geographic scale. While hospital-based data is available, and an inexpensive source of data, there is uncertainty about the reliability of this data source. Additionally, clinical malaria incidence in the highland regions of western Kenya remains so high that intensive vector control measures and new antimalarial treatment regimes are being implemented. The objectives of this application are to determine the reliability of hospital-based malaria case data for representing natural malaria incidence and for the usefulness of this data in impact evaluation of malaria control measures, and to determine the risk factors for clinical malaria infection in areas undergoing intensive malaria intervention. I have designed two specific aims. The first specific aim tests the hypothesis that misdiagnosis, home treatment and hospital treatment-seeking behaviour are the major sources of errors in hospital-based malaria case data for representing natural malaria incidence rates. The second specific aim tests the hypothesis that clinical malaria infection risk in individual households may be affected by biotic and abiotic factors, and socioeconomic matters, and the importance of the risk factors for clinical malaria may be determined by using case-control studies. This research will answer important questions such as whether hospital-based malaria case data are suitable for malaria incidence monitoring and impact evaluation of malaria control efforts, and will help to develop new methods that target the important risk factors for clinical malaria in the era of intensive malaria control in Africa.