快速城市疟疾评估（RUMA）III：约普贡市（阿比让）城市疟疾流行病学

Rapid Urban Malaria Appraisal (RUMA) III: epidemiology of urban malaria in the municipality of Yopougon (Abidjan).

作者信息

Wang Shr-Jie, Lengeler Christian, Smith Thomas A, Vounatsou Penelope, Cissé Guéladio, Tanner Marcel

机构信息

Swiss Tropical Institute (STI), P.O. Box, CH-4002 Basel, Switzerland.

出版信息

Malar J. 2006 Apr 4;5:29. doi: 10.1186/1475-2875-5-28.

BACKGROUND

Currently, there is a significant lack of knowledge concerning urban malaria patterns in general and in Abidjan in particular. The prevalence of malaria, its distribution in the city and the fractions of fevers attributable to malaria in the health facilities have not been previously investigated.

METHODS

A health facility-based survey and health care system evaluation was carried out in a peripheral municipality of Abidjan (Yopougon) during the rainy season of 2002, applying a standardized Rapid Urban Malaria Appraisal (RUMA) methodology.

RESULTS

According to national statistics, approximately 240,000 malaria cases (both clinical cases and laboratory confirmed cases) were reported by health facilities in the whole of Abidjan in 2001. They accounted for 40% of all consultations. In the health facilities of the Yopougon municipality, the malaria infection rates in fever cases for different age groups were 22.1% (under one year-olds), 42.8% (one to five years-olds), 42.0% (> five to 15 years-olds) and 26.8% (over 15 years-olds), while those in the control group were 13.0%. 26.7%, 21.8% and 14.6%, respectively. The fractions of malaria-attributable fever were 0.12, 0.22, 0.27 and 0.13 in the same age groups. Parasitaemia was homogenously detected in different areas of Yopougon. Among all children, 10.1% used a mosquito net (treated or not) the night before the survey and this was protective (OR = 0.52, 95% CI 0.29-0.97). Travel to rural areas within the last three months was frequent (31% of all respondents) and associated with a malaria infection (OR = 1.75, 95% CI 1.25-2.45).

CONCLUSION

Rapid urbanization has changed malaria epidemiology in Abidjan and endemicity was found to be moderate in Yopougon. Routine health statistics are not fully reliable to assess the burden of disease, and the low level of the fractions of malaria-attributable fevers indicated substantial over-treatment of malaria.

背景

目前，人们对城市疟疾模式，尤其是阿比让的疟疾模式普遍缺乏了解。疟疾的患病率、在城市中的分布情况以及医疗机构中由疟疾引起的发热比例此前均未得到调查。

方法

2002年雨季期间，在阿比让的一个外围市镇（约普贡）开展了一项基于医疗机构的调查和卫生保健系统评估，采用标准化的快速城市疟疾评估（RUMA）方法。

结果

根据国家统计数据，2001年阿比让全市的医疗机构共报告了约24万例疟疾病例（包括临床病例和实验室确诊病例）。这些病例占所有会诊病例的40%。在约普贡市镇的医疗机构中，不同年龄组发热病例的疟疾感染率分别为22.1%（1岁以下儿童）、42.8%（1至5岁儿童）、42.0%（5至15岁儿童）和26.8%（15岁以上人群），而对照组的感染率分别为13.0%、26.7%、21.8%和14.6%。相同年龄组中由疟疾引起的发热比例分别为0.12、0.22、0.27和0.13。在约普贡的不同区域均均匀检测到疟原虫血症。在所有儿童中，10.1%的儿童在调查前一晚使用了蚊帐（无论是否经过处理），这具有保护作用（比值比=0.52，95%置信区间0.29-0.97）。在过去三个月内前往农村地区的情况较为常见（占所有受访者的31%），且与疟疾感染相关（比值比=1.75，95%置信区间1.25-2.45）。