Klinkenberg Eveline, van der Hoek Wim, Amerasinghe Felix P
International Water Management Institute (IWMI), P.O. Box 2075, Colombo, Sri Lanka.
Acta Trop. 2004 Jan;89(2):215-25. doi: 10.1016/j.actatropica.2003.08.007.
Malaria in Sri Lanka is unstable and epidemic, with large spatial and temporal differences in transmission dynamics. The disease is of great public health significance and identification of underlying risk factors is important in order to use the limited resources in a cost-effective way. The International Water Management Institute (IWMI) recently launched a project of GIS-based malaria risk mapping in Sri Lanka, to investigate whether this tool could be used for epidemic forecasting and for the planning of malaria control activities. This paper presents results for the Uda Walawe region in southern Sri Lanka, an irrigated agricultural area where malaria cases were mapped at the smallest administrative level for each month over a 10-year period. Malaria incidence rates were related to land- and water-use patterns, socio-economic features, and data on malaria control interventions in a multivariate analysis. Areas of high malaria risk were characterized by: (i) higher than average rainfall, (ii) greater forest coverage; (iii) slash and burn cultivation as a predominant agricultural activity; (iv) presence of many abandoned irrigation reservoirs; and (v) poor socio-economic status. Irrigated rice cultivation areas had a lower risk of malaria than non-irrigated areas. This difference could be due to socio-economic factors related to irrigation development and/or transmission dynamics related to vector density or species composition. Our findings call for malaria control strategies that are readily adapted to different ecological and epidemiological settings. Malaria risk maps are a convenient tool for discussing targeted and cost-effective interventions with disease control personnel.
斯里兰卡的疟疾疫情不稳定且呈流行态势，传播动态在空间和时间上存在很大差异。该疾病具有重大的公共卫生意义，识别潜在风险因素对于以具有成本效益的方式利用有限资源至关重要。国际水管理研究所（IWMI）最近在斯里兰卡启动了一个基于地理信息系统（GIS）的疟疾风险绘图项目，以调查该工具是否可用于疫情预测和疟疾控制活动规划。本文展示了斯里兰卡南部乌达瓦拉维地区的研究结果，该地区是一个灌溉农业区，在10年期间每月按最小行政级别绘制疟疾病例分布图。在多变量分析中，疟疾发病率与土地和水资源利用模式、社会经济特征以及疟疾控制干预措施数据相关。疟疾高风险地区的特征包括：（i）降雨量高于平均水平；（ii）森林覆盖率更高；（iii）刀耕火种作为主要农业活动；（iv）存在许多废弃灌溉水库；（v）社会经济地位低下。灌溉水稻种植区的疟疾风险低于非灌溉区。这种差异可能是由于与灌溉发展相关的社会经济因素和/或与病媒密度或物种组成相关的传播动态。我们的研究结果呼吁采取易于适应不同生态和流行病学环境的疟疾控制策略。疟疾风险地图是与疾病控制人员讨论有针对性和具有成本效益的干预措施的便捷工具。
