Wang Shr-Jie, Lengeler Christian, Mtasiwa Deodatus, Mshana Thomas, Manane Lusinge, Maro Godson, Tanner Marcel
Swiss Tropical Institute, P.O. Box, CH-4002 Basel, Switzerland.
Malar J. 2006 Apr 4;5:28. doi: 10.1186/1475-2875-5-29.
The thinking behind malaria research and control strategies stems largely from experience gained in rural areas and needs to be adapted to the urban environment.
A rapid assessment of urban malaria was conducted in Dar es Salaam in June-August, 2003 using a standard Rapid Urban Malaria Appraisal (RUMA) methodology. This study was part of a multi-site study in sub-Saharan Africa supported by the Roll Back Malaria Partnership.
Overall, around one million cases of malaria are reported every year by health facilities. However, school surveys in Dar es Salaam during a dry spell in 2003 showed that the prevalence of malaria parasites was low: 0.8%, 1.4%, 2.7% and 3.7% in the centre, intermediate, periphery and surrounding rural areas, respectively. Health facilities surveys showed that only 37/717 (5.2%) of presenting fever cases and 22/781 (2.8%) of non-fever cases were positive by blood slide. As a result, malaria-attributable fractions for fever episodes were low in all age groups and there was an important over-reporting of malaria cases. Increased malarial infection rates were seen in persons who travelled to rural areas within the past three months. A remarkably high coverage of insecticide-treated nets and a corresponding reduction in malarial infection risk were found.
The number of clinical malaria cases was much lower than routine reporting suggested. Improved malaria diagnosis and re-defined clinical guidelines are urgently required to avoid over-treatment with antimalarials.
疟疾研究与控制策略背后的思路很大程度上源于在农村地区获得的经验，需要根据城市环境进行调整。
2003年6月至8月，在达累斯萨拉姆采用标准的城市疟疾快速评估（RUMA）方法对城市疟疾进行了快速评估。本研究是由减疟伙伴关系支持的撒哈拉以南非洲多地点研究的一部分。
总体而言，卫生设施每年报告约100万例疟疾病例。然而，2003年旱季期间在达累斯萨拉姆进行的学校调查显示，疟原虫感染率较低：市中心、中间区域、周边地区和周边农村地区的感染率分别为0.8%、1.4%、2.7%和3.7%。卫生设施调查显示，在就诊的发热病例中，只有37/717（5.2%）通过血涂片检测呈阳性，在非发热病例中，只有22/781（2.8%）呈阳性。因此，各年龄组发热发作的疟疾归因比例都很低，而且疟疾病例存在严重的过度报告情况。在过去三个月内前往农村地区的人群中，疟疾感染率有所上升。发现经杀虫剂处理的蚊帐覆盖率非常高，相应地降低了疟疾感染风险。
临床疟疾病例数远低于常规报告显示的数字。迫切需要改进疟疾诊断并重新制定临床指南，以避免抗疟药的过度治疗。
