Center for the Study of Complex Malaria in India

研究类型2：总结 该项目的目标是进行混合方法、基于社会网络的社会行为研究，以 确定哪些类型的疟疾预防干预措施通过良好的覆盖面和使用减少疟疾，以及 确定东北部州疟疾控制措施的需求和/或供应方障碍 印度梅加拉亚。在这一地区，疟疾局势是动态的。2012-2015年间，案件稳步增加，但 自那以后，疫情呈下降趋势，2017年报告的病例最少。这一急剧下降 归因于2016年分发了长效杀虫剂浸泡蚊帐和 部分采用室内滞留喷洒(IRS)和滴滴涕(DDT)。然而，残留病例仍然是地方性疾病， 而要设计适当的淘汰策略，我们必须努力了解这些情况的原因。数据 梅加拉亚卫生部疟疾司和复合体研究中心 印度疟疾(CSCMi)正在进行的流行病学研究表明，社区对IRS、滥用 LLIN，无保护的户外活动，以及无症状、亚显微和催眠动物的隐藏水库 感染都有助于疟疾的地方性持久流行。在巴拉托PHC(初级卫生中心)和 梅加拉亚的农朗初级保健中心，每个地点有10个村庄将成为流行病学研究的资助对象 通过母公司CSCMi 2.0拨款。在目标1中，我们计划检查疟疾预防措施是如何 在实践中采用，使用非参与者观察的人种学方法；在目标2中，我们将探索 使用定性访谈和焦点小组，预防措施可能面临的文化和社会障碍 讨论(FGD)；在目标3中，我们将评估哪些社区成员最有可能影响 村民接受或拒绝此类措施，使用社会网络分析调查。当这些目标达到 ，他们的发现将被总结并与其他CSCMi研究的结果相结合 (流行病学，媒介)正在巴拉托和农朗初级保健中心进行疟疾情况分析，以便 牵涉到的村庄。这将使人们更好地了解疟疾的局部流行病学以及障碍。 以及现有干预措施的机会(例如，LLIN、IRS)，以及其他干预措施的可能性 (例如，疟疾病例家庭成员的治疗)。它还将使我们能够提供建议，以 国家疟疾控制计划，以采取可能促进或提高有效性的额外措施 美国国税局和LLIN的长期目标是在梅加拉亚彻底消灭疟疾。

STUDY TYPE 2: SUMMARY The goal of this project is to conduct mixed methods, social network-based, socio-behavioral studies to determine what types of malaria-preventive interventions reduce malaria through good coverage and use, and to identify demand and/or supply side barriers to malaria control measures in the northeastern state of Meghalaya, India. In this area the malaria situation is dynamic. Cases steadily increased from 2012-2015, but since then there has been a downward trend, and 2017 had the fewest cases ever reported. This steep decline has been attributed to the distribution of long-lasting insecticide impregnated bednets (LLINs) in 2016 and partial adoption of indoor residual spraying (IRS) with DDT. Nevertheless, residual cases remain endemic, and to design an appropriate elimination strategy, we must try to understand the reasons for these cases. Data from the Meghalaya Department of Health Malaria Division and from the Center for the Study of Complex Malaria in India (CSCMi) ongoing epidemiology studies suggest that community resistance to IRS, misuse of LLINs, unprotected outdoor activity, and hidden reservoirs of asymptomatic, submicroscopic, and hypnozoite infections all contribute to the endemic persistence of malaria. At Barato PHC (primary health center) and Nonglang PHC in Meghalaya, 10 villages in each site will be subjects of epidemiological studies funded through the parent CSCMi 2.0 grant. In Aim 1 we plan to examine how malaria-preventive measures are adopted in practice, using ethnographic methods of non-participant observations; in Aim 2 we will explore the cultural and social barriers preventive measures may face, using qualitative interviews and focus group discussions (FGDs); and in Aim 3 we will assess which community members are most likely to influence villagers to accept or reject such measures, using social network analysis surveys. When these Aims have been concluded, their findings will be summarized and integrated with those of other CSCMi studies (epidemiology, vector) underway at the Barato and Nonglang PHCs into a malaria situation analysis for the villages involved. This will yield a better understanding of the focal malaria epidemiology, as well as barriers and opportunities to current interventions used (e.g., LLINs, IRS), and possibilities for additional interventions (e.g., treatment of household members of malaria cases). It will also enable us to provide recommendations to the state malaria control program for additional measures that are likely to foster or improve the effectiveness of IRS and LLINs, with the long-term objective of complete elimination of malaria in Meghalaya.