Snow Robert W, Korenromp Eline L, Gouws Eleanor
Kenya Medical Research Institute-Wellcome Trust Collaborative Program, Nairobi, Kenya.
Am J Trop Med Hyg. 2004 Aug;71(2 Suppl):16-24.
The disability adjusted life year (DALY) approach of defining cause-specific health burdens is becoming the benchmark for international disease control prioritization. For malaria, this categorical approach may not fully capture its burden that includes chronic anemia, low birth weight, and enhancement of the severity of other childhood diseases. We investigated the extent to which malaria acts as a risk factor for all-cause mortality in African children less than five years of age from 1) ecologic associations between Plasmodium falciparum infection prevalence (PR) and under-five mortality, and 2) reductions in all-cause under-five mortality achieved in malaria intervention trials. Across 48 demographic surveillance studies, when adjusted for secular trends, PR more than doubled all-cause mortality (P = 0.0001). Trials of insecticide-treated mosquito nets generally found smaller population-attributable fractions of pediatric mortality to malaria infection, which may relate to their imperfect coverage and efficacy. In conclusion, the disability and death burden due to malaria in African children could be higher than that detectable from cause-specific DALY estimations.
采用伤残调整生命年（DALY）方法来界定特定病因的健康负担，正成为国际疾病控制优先次序设定的基准。对于疟疾而言，这种分类方法可能无法完全涵盖其负担，包括慢性贫血、低出生体重以及其他儿童疾病严重程度的增加。我们从以下两个方面调查了疟疾作为5岁以下非洲儿童全因死亡率风险因素的程度：1）恶性疟原虫感染率（PR）与5岁以下儿童死亡率之间的生态学关联；2）疟疾干预试验中5岁以下儿童全因死亡率的降低情况。在48项人口监测研究中，经长期趋势调整后，PR使全因死亡率增加了一倍多（P = 0.0001）。使用杀虫剂处理过的蚊帐进行的试验通常发现，疟疾感染导致的儿童死亡率在人群归因分数中所占比例较小，这可能与其覆盖范围和效果不完善有关。总之，非洲儿童因疟疾导致的残疾和死亡负担可能高于特定病因DALY估计所能检测到的负担。
