EPIDEMIOLOGY OF CLINICAL MALARIA IN WESTERN KENYA HIGHLANDS

描述(申请人提供)：肯尼亚西部临床疟疾流行病学高地疟疾是非洲的一个主要公共卫生问题。据估计，非洲每年有100万人死于疟疾，其中大多数死亡病例发生在撒哈拉以南地区的5岁以下儿童中。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，自20世纪80年代S以来，那里经历了周期性的流行病，每年有110,000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，肯尼亚于2006年开始了密集的防治工作。这些努力包括大规模分发驱虫蚊帐、室内滞留喷洒以及使用以青蒿素为基础的综合疗法(ACT)来治疗简单的疟疾。尽管这些控制措施似乎在降低疟疾流行率和发病率方面取得了成功，但对这些努力没有严格的监测和评估方案，因为关于疟疾流行率和发病率的数据往往很难或过于昂贵，难以在大范围内获得。虽然基于医院的数据是可用的，而且是一种廉价的数据源，但这种数据源的可靠性存在不确定性。此外，肯尼亚西部高原地区的疟疾临床发病率仍然很高，因此正在实施密集的病媒控制措施和新的抗疟疾治疗制度。这一应用程序的目的是确定以医院为基础的疟疾病例数据代表自然疟疾发病率的可靠性，以及该数据在疟疾控制措施的影响评估中的有用性，并确定在进行密集疟疾干预的地区临床疟疾感染的危险因素。我设计了两个具体的目标。第一个具体目的是检验这样一种假设，即误诊、家庭治疗和医院求医行为是以医院为基础的疟疾病例数据中错误的主要来源，以代表疟疾自然发病率。第二个具体目的是检验以下假设，即个体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，并且可以通过病例对照研究来确定风险因素对临床疟疾的重要性。这项研究将回答以医院为基础的疟疾病例数据是否适合疟疾发病率监测和疟疾控制工作的影响评估等重要问题，并将有助于开发新的方法，针对非洲疟疾密集控制时代临床疟疾的重要风险因素。

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.