Brinkmann U, Brinkmann A
Department of Population Sciences, Harvard School of Public Health, Boston, MA 02115.
Trop Med Parasitol. 1991 Sep;42(3):204-13.
The World Health Organization does not give any data on the malaria situation in Africa in its regular reports because of the "insufficiency and irregularity of reporting". Estimates on the total number of cases and the number of deaths vary considerably. They range from 35 million to 189 million per year depending on whose figures one uses. An intensive search of the literature using computer-based systems identified more than 1000 titles on the epidemiology of malaria. Out of them and from other sources finally 426 articles were used to describe the current malaria situation and observable trends in Africa. Major findings were that malaria is responsible for about 40% of fever cases, mortality is about 5 per 1000 per year, case fatality ranges from 2% to 24%. Admissions for malaria account for 20% to 50% of all admissions in African health services although only 8% to 25% of persons with malaria visit health services. Self-treatment is more common in urban areas (more than 60%) but an increasing number of people use some form of self protection in rural areas (2% to 25%). The resistance of malaria parasites to chloroquine and other drugs is widespread. Chloroquine resistance has reached a prevalence of about 30% at the RII level in most countries. Malaria incidence shows annual growth rates of 7.3% for Zambia, 10.4% for Togo, and 21.0% for Rwanda. The data for Burkina Faso show a downward trend of--14.7% during the years from 1973 to 1981. Since then malaria incidence is increasing at 11.0% per year. Hospital data reported from Zambia indicate that mortality is rising 5.2% per annum in children and 9.7% per annum in adults. Reasons for the increase of malaria and its role for development are discussed.
世界卫生组织在其定期报告中未提供非洲疟疾情况的任何数据，原因是“报告不足且不规律”。对病例总数和死亡人数的估计差异很大。根据所采用的数据来源不同，每年的病例数估计在3500万至1.89亿例之间。利用计算机系统对文献进行的深入检索，找出了1000多篇关于疟疾流行病学的文章。从这些文章及其他来源中，最终选用了426篇文章来描述非洲当前的疟疾情况及可观察到的趋势。主要研究结果如下：疟疾约占发热病例的40%，死亡率约为每年千分之五，病死率在2%至24%之间。在非洲的医疗卫生机构中，疟疾患者的住院人数占总住院人数的20%至50%，尽管只有8%至25%的疟疾患者前往医疗卫生机构就诊。自我治疗在城市地区更为普遍（超过60%），但在农村地区，越来越多的人采用某种形式的自我防护措施（2%至25%）。疟原虫对氯喹及其他药物的耐药性普遍存在。在大多数国家，氯喹耐药率在RII水平已达到约30%。赞比亚的疟疾发病率年增长率为7.3%，多哥为10.4%，卢旺达为21.0%。布基纳法索1973年至1981年期间的数据呈下降趋势，下降了14.7%。自那时起，疟疾发病率每年以11.0%的速度上升。赞比亚报告的医院数据表明，儿童疟疾死亡率每年上升5.2%，成人上升9.7%。文中讨论了疟疾增加的原因及其对发展的影响。
