Malaria Epidemiology in an Urban Setting

项目总结(见说明)： 尽管撒哈拉以南非洲的大部分地区都在快速城市化和环境变化，但人们对疟疾在城市环境中的传播和疟疾仍然知之甚少。城市疾病和媒介丰富的有限流行病学证据表明，由于发病率似乎在增加，存在相当大的异质性。这项研究将调查马拉维布兰太尔及其周围城市地区疟疾风险的各种生态、社会和行为决定因素，以更好地了解家庭规模的传播和疾病驱动因素。标准的流行病学方法与涉及卫星图像、时空统计和分子诊断的新工具相结合，将解决四个目标。在目标1下，我们将利用现有的被动病例监测(2002-2015年)和国土安全部的三轮主动监测，确定马拉维各地疟疾发病率的变化特征，并确定与特定环境特征的关联。目的2是一项以卫生机构为基础的多年病例对照研究，研究对象为6名59个月大的S，来自不同社会、生态环境和城市化水平的家庭。包括旅行在内的资产和行为的重要性，因为它们影响住房内/周围传播的变化，将通过伴随家庭条件观察的调查问卷来探索。目标3下的研究将在两年内扩大这项工作，确定不同城市和农村栖息地的人和蚊子的基于SNP的疟原虫基因类型，以进一步探索传播地点。目标4中的时间序列分析将处理环境引起的流行病的时空变异性和风险。将评估住房的社会、经济和生态特征，以更好地适应城乡连续体。我们共同寻求更好地了解疟疾风险的多种驱动因素之间的复杂相互作用。 这种城乡连续体所代表的条件，并决定了哪些最容易受到 干预。归根结底，这些研究应该有助于为预防政策提供信息并有效地提供 对最需要帮助的人进行干预。

PROJECT SUMMARY (See instructions): Despite rapid urbanization and environmental changes in most areas of sub-Saharan Africa, Plasmodium transmission and malaria disease in urban settings remains pooriy understood. Limited epidemiological evidence of urban disease and vector abundance suggests considerable heterogeneity, as incidence appears to be increasing. This study will investigate diverse ecological, social, and behavioral determinants of malaria risk in and around urban areas of Blantyre, Malawi to better understand household-scale drivers of transmission and disease. Standard epidemiological methods, combined with new tools involving satellite images, space-time statistics and molecular diagnosis will address four Aims. Under Aim 1, we will characterize variation in malaria incidence throughout Malawi and determine associations with specific environmental characteristics using existing passive surveillance of cases (2002-2015) and three rounds of DHS active surveillance. Aim 2 involves a multi-year, health-facility-based, case-control study of Plasmodium infection and malaria in 6 s 59 month-old children from households in diverse social and ecological environments and levels of urbanicity. The importance of assets and behaviors, including travel, as they affect variation in transmission in/around housholds will be explored through questionnaires that accompany observations of household conditions. Studies under Aim 3 will expand on this work during two years by characterizing SNP-based genotypes of Plasmodium from people and mosquitoes in different urban and rural habitats to further explore transmission locations. Time series analyses in Aim 4 will address space-time variability and risk of environmentally-promoted epidemics. Social, economic and ecologic characteristics of housholds will be evaluated to better contextualize the urban-rural continuum. Together, we seek to better understand the complex interplay of multiple drivers of malaria risk across the spectrum of conditions represented by this urban-rural continuum, and determine which are most amenable to intervention. Ultimately, these studies should help to inform prevention policy and efficient delivery of interventions to those in greatest need.