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，其中大多数死亡者是撒哈拉以南地区5岁以下的儿童。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，自20世纪80年代以来，疟疾出现周期性流行，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年在肯尼亚开展了密集的防治工作。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青蒿素类复方疗法治疗无并发症的疟疾。虽然这些控制措施在降低疟疾流行率和发病率方面似乎是成功的，但这些努力没有严格的监测和评价方案，因为在大的地理范围内获得疟疾流行率和发病率的数据往往很困难或过于昂贵。虽然医院的数据是可用的，而且是一种廉价的数据来源，但这种数据来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治疗制度。该应用程序的目的是确定医院疟疾病例数据的可靠性，以代表自然疟疾发病率，并确定这些数据在疟疾控制措施的影响评价中的有用性，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。我设定了两个具体目标。第一个具体目标是检验以下假设：误诊、家庭治疗和到医院寻求治疗的行为是医院疟疾病例数据中代表自然疟疾发病率的错误的主要来源。第二个具体目标是检验以下假设，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因素的影响，临床疟疾风险因素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，如基于医院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，并将有助于开发针对非洲强化疟疾控制时代临床疟疾重要风险因素的新方法。

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.