Barnes Karen I, Durrheim David N, Little Francesca, Jackson Amanda, Mehta Ushma, Allen Elizabeth, Dlamini Sicelo S, Tsoka Joyce, Bredenkamp Barry, Mthembu D Jotham, White Nicholas J, Sharp Brian L
Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa.
PLoS Med. 2005 Nov;2(11):e330. doi: 10.1371/journal.pmed.0020330. Epub 2005 Oct 4.
Between 1995 and 2000, KwaZulu-Natal province, South Africa, experienced a marked increase in Plasmodium falciparum malaria, fuelled by pyrethroid and sulfadoxine-pyrimethamine resistance. In response, vector control was strengthened and artemether-lumefantrine (AL) was deployed in the first Ministry of Health artemisinin-based combination treatment policy in Africa. In South Africa, effective vector and parasite control had historically ensured low-intensity malaria transmission. Malaria is diagnosed definitively and treatment is provided free of charge in reasonably accessible public-sector health-care facilities.
We reviewed four years of malaria morbidity and mortality data at four sentinel health-care facilities within KwaZulu-Natal's malaria-endemic area. In the year following improved vector control and implementation of AL treatment, malaria-related admissions and deaths both declined by 89%, and outpatient visits decreased by 85% at the sentinel facilities. By 2003, malaria-related outpatient cases and admissions had fallen by 99%, and malaria-related deaths had decreased by 97%. There was a concomitant marked and sustained decline in notified malaria throughout the province. No serious adverse events were associated causally with AL treatment in an active sentinel pharmacovigilance survey. In a prospective study with 42 d follow up, AL cured 97/98 (99%) and prevented gametocyte developing in all patients. Consistent with the findings of focus group discussions, a household survey found self-reported adherence to the six-dose AL regimen was 96%.
Together with concurrent strengthening of vector control measures, the antimalarial treatment policy change to AL in KwaZulu-Natal contributed to a marked and sustained decrease in malaria cases, admissions, and deaths, by greatly improving clinical and parasitological cure rates and reducing gametocyte carriage.
1995年至2000年间，南非夸祖鲁 - 纳塔尔省恶性疟原虫疟疾显著增加，这是由拟除虫菊酯和磺胺多辛 - 乙胺嘧啶耐药性引发的。作为应对措施，加强了病媒控制，并在非洲卫生部首个基于青蒿素的联合治疗政策中采用了蒿甲醚 - 本芴醇（AL）。在南非，有效的病媒和寄生虫控制历来确保了低强度的疟疾传播。在可合理到达的公共部门医疗设施中，疟疾可得到明确诊断且治疗免费。
我们回顾了夸祖鲁 - 纳塔尔省疟疾流行区四家哨点医疗机构四年的疟疾发病率和死亡率数据。在改善病媒控制和实施AL治疗后的一年里，哨点医疗机构的疟疾相关住院人数和死亡人数均下降了89%，门诊就诊人数下降了85%。到2003年，疟疾相关门诊病例和住院人数下降了99%，疟疾相关死亡人数下降了97%。全省报告的疟疾也随之显著且持续下降。在一项活跃的哨点药物警戒调查中，没有严重不良事件与AL治疗有因果关联。在一项为期42天随访的前瞻性研究中，AL治愈了97/98（99%）的患者，并防止了所有患者体内配子体的发育。与焦点小组讨论的结果一致，一项家庭调查发现自我报告的六剂AL治疗方案依从率为96%。
在夸祖鲁 - 纳塔尔省，抗疟治疗政策改为使用AL，再加上同时加强病媒控制措施，通过大幅提高临床和寄生虫学治愈率以及减少配子体携带，使疟疾病例、住院人数和死亡人数显著且持续下降。
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