EPIDEMIOLOGY OF CLINICAL MALARIA IN WESTERN KENYA HIGHLANDS

肯尼亚西部高地临床疟疾的流行病学

• 批准号: 7936540
• 负责人: YAW ASARE AFRANE
• 金额: $ 5.4万
• 依托单位: KENYA MEDICAL RESEARCH INSTITUTE (KEMRI)
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-02-15 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7936540
• 关键词: Affect; Africa; Africa South of the Sahara; African; Age; Antimalarials; Area; Artemisinins; Behavior; Breeding; Case-Control Studies; Child; Clinic; Clinical; Clinical Data; Clinical Distribution; Combined Modality Therapy; Communities; Culicidae; Data; Data Sources; Databases; Diagnosis; Drug resistance; Epidemic; Epidemiology; Error Sources; Foundations; Funding; Genotype; Habitats; Home environment; Hospitals; Household; Housing; Impact evaluation; Incidence; Individual; Infection; Insecticides; Intervention; Kenya; Knowledge; Link; Location; Malaria; Measures; Methods; Molecular Analysis; Monitor; Morbidity - disease rate; Parasites; Prevalence; Program Evaluation; Public Health; Research; Residual state; Risk; Risk Factors; Sahara; Sea; Site; Socioeconomic Factors; Source; Testing; Travel; Treatment Effectiveness; Uncertainty; artemisinine; base; clinical epidemiology; combat; cost effective; design; effective intervention; experience; fighting; improved; intervention program; killings; novel; programs; vector; vector control

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. PUBLIC HEALTH RELEVANCE: Epidemic malaria in the African highlands kills about 110,000 people each year and 110 million people are at risk of malaria infection. Understanding the risk factors for clinical malaria infection in the highlands will help to develop cost-effective interventions to combat malaria epidemics. The accuracy and sensitivity of hospital-based clinical malaria data is essential to measure the impact of malaria interventions.

描述（由申请人提供）：肯尼亚西部高地临床疟疾的流行病学 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，其中大多数死亡病例是撒哈拉以南地区 5 岁以下的儿童。非洲高地（海拔1500米以上地区）原本没有疟疾或疟疾很少，但自20世纪80年代以来，疟疾周期性流行，每年死亡人数超过11万人。在全球抗击疟疾基金、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、室内滞留喷洒以及使用基于青蒿素的联合疗法（ACT）来治疗无并发症的疟疾。尽管这些控制措施在减少疟疾流行和发病率方面似乎取得了成功，但对这些努力没有严格的监测和评估计划，因为在大地理范围内获取有关疟疾流行和发病率的数据往往很困难或过于昂贵。虽然基于医院的数据是可用的，并且数据源价格低廉，但该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治疗方案。本应用程序的目的是确定医院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影响评估中的有用性，并确定正在接受疟疾密集干预的地区临床疟疾感染的危险因素。我设计了两个具体目标。第一个具体目标检验了以下假设：误诊、家庭治疗和医院就诊行为是代表自然疟疾发病率的医院疟疾病例数据的错误的主要来源。第二个具体目标检验以下假设：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因素的影响，并且可以通过病例对照研究确定临床疟疾风险因素的重要性。这项研究将回答诸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影响评估等重要问题，并将有助于开发针对非洲疟疾强化控制时代临床疟疾重要危险因素的新方法。 公共卫生相关性：非洲高地的流行性疟疾每年导致约 11 万人死亡，1.1 亿人面临感染疟疾的风险。了解高地临床疟疾感染的危险因素将有助于制定具有成本效益的干预措施来对抗疟疾流行。医院临床疟疾数据的准确性和敏感性对于衡量疟疾干预措施的影响至关重要。