Coene J
Laboratory of Parasitology/University of Kinshasa, Antwerp, Belgium.
Ann Soc Belg Med Trop. 1991;71 Suppl 1:103-12.
Malaria is a major cause of paediatric illness and death in Kinshasa, and all 3 million inhabitants are at risk. In view of the increasing chloroquine-resistance of Plasmodium falciparum, the early treatment of fever cases as the sole malaria control measure is no longer acceptable. The prospects for vector control are determined by the effectiveness, the acceptability and the practicability of the various methods in the local conditions of Kinshasa. Pronounced differences in the level of endemicity exist between the various parts of the town. These differences, and the ecological and socio-economic factors that underlie them, must be taken into account when estimating the potential of a control method. The reduction of man-vector contact through personal protection with impregnated bednets is the only realistic goal at this moment, but even a very marked decrease of the inoculation rate will produce little apparent effect in the highly endemic (semi-)rural districts at the periphery of town. In the urbanized center of Kinshasa, where the moderate to low intensity of transmission is more susceptible to a critical reduction, the same method may have an impact on malaria morbidity. Moreover, the big nuisance from non-vector mosquitoes in the urban area is an important motivating factor for the acceptance and the use of bednets. A mass effect, on the other hand, only is to be expected in isolated villages. Field trials are needed to evaluate the short- and long-term effect on malaria transmission and on its' clinical expression, as well as on the build-up of natural immunity, in the epidemiologically distinct areas. However, the final outcome of a large scale implementation of malaria control with impregnated mosquitonets will equally depend on health education, on the availability of bednets at low cost, on the creation of the appropriate structures for the (re)impregnation and distribution of the nets, and finally on the sustainability of the whole effort.
疟疾是金沙萨儿童患病和死亡的主要原因，该市所有300万居民都面临风险。鉴于恶性疟原虫对氯喹的耐药性不断增加，将发热病例的早期治疗作为唯一的疟疾控制措施已不再可行。病媒控制的前景取决于各种方法在金沙萨当地条件下的有效性、可接受性和实用性。该市不同区域的疟疾流行程度存在显著差异。在评估一种控制方法的潜力时，必须考虑到这些差异以及作为其基础的生态和社会经济因素。目前，通过使用浸药蚊帐进行个人防护来减少人与病媒的接触是唯一现实的目标，但即使接种率显著下降，在城市周边高度流行的（半）农村地区也不会产生明显效果。在金沙萨的城市化中心，疟疾传播强度为中度至低度，更容易因临界降低而受到影响，同样的方法可能会对疟疾发病率产生影响。此外，城市地区非病媒蚊子造成的严重滋扰是人们接受和使用蚊帐的一个重要推动因素。另一方面，只有在孤立的村庄才有望产生群体效应。需要进行实地试验，以评估在流行病学特征不同的地区，疟疾控制措施对疟疾传播及其临床表现，以及对自然免疫力形成的短期和长期影响。然而，大规模实施浸药蚊帐疟疾控制措施的最终结果同样将取决于健康教育、低成本蚊帐的供应、建立蚊帐（再）浸药和分发的适当机构，以及整个努力能否持续下去。
