Das Lalit K, Jambulingam Purushothaman, Sadanandane Candasamy
Vector Control Research Centre, Indian Council of Medical Research, Indira Nagar, Pondicherry-605006, India.
Malar J. 2008 May 5;7:75. doi: 10.1186/1475-2875-7-75.
In the Global Strategy for Malaria Control, one of the basic elements is early detection and prompt treatment of malaria cases, especially in areas where health care facilities are inadequate. Establishing or reviving the existing drug distribution centers (DDC) at the peripheral levels of health care can achieve this. The DDCs should be operationally feasible, acceptable by community and technical efficient, particularly in remote hard-core malaria endemic areas.
Volunteers from villages were selected for distribution of chloroquine and the selection was made either by villagers or head of the village. The services of the volunteers were absolutely free and voluntary in nature. Chloroquine was provided free of charge to all fever cases. The impact was evaluated based on the changes observed in fever days, fever incidence, parasite incidence and parasite prevalence (proportion of persons harbouring malaria parasite) in the community. Comparisons were made between 1st, 2nd and 3rd year of operation in the experimental villages and between the experimental and check areas.
A total of 411 village volunteers in 378 villages in the experimental community health center with a population of 125,439 treated 88,575 fever cases with a mean annual incidence of 331.8 cases per 1,000 population during the three-year study period. The average morbid days due to fever (AFD) was reduced to 1.6 +/- 0.1 from 5.9 +/- 2.1 in the experimental villages while it remained at 5.0 +/- 1.0 in the check villages. There was a significant reduction, (p < 0.05) in Annual Fever Incidence (AFI) in the experimental hilltop and foothill villages in comparison to check villages. The change in Annual Parasite Incidence (API) was, however, not statistically significant (p > 0.05). In plain villages that were low endemic, the reductions in AFI and API in experimental villages were statistically significant (p < 0.05). There was significant reduction in the parasite prevalence in high endemic villages of the experimental area both during 2nd and 3rd year when compared with the check area (p < 0.05) but no such reduction was observed in low endemic areas (p > 0.0.5). Mortality due to malaria declined by 75% in the experimental villages in the adult age group whereas there was an increasing trend in check villages.
The study demonstrated that a passive chloroquine distribution system operated by village volunteers in tribal areas is feasible and effective in reducing malaria-related morbidity and mortality.
在《全球疟疾控制战略》中，基本要素之一是对疟疾病例进行早期检测和及时治疗，尤其是在医疗保健设施不足的地区。在医疗保健的基层建立或恢复现有的药品分发中心（DDC）可以实现这一点。DDC在操作上应切实可行，为社区所接受且技术高效，特别是在偏远的疟疾核心流行地区。
从村庄中挑选志愿者来分发氯喹，挑选工作由村民或村长进行。志愿者的服务完全免费且出于自愿。向所有发热病例免费提供氯喹。根据社区中观察到的发热天数、发热发病率、寄生虫发病率和寄生虫流行率（携带疟原虫者的比例）的变化来评估影响。对实验村庄运营的第1年、第2年和第3年之间以及实验区和对照区之间进行了比较。
在为期三年的研究期间，实验社区卫生中心所在的378个村庄中的411名村庄志愿者，为125,439人口中的88,575例发热病例提供了治疗，平均年发病率为每1000人口331.8例。实验村庄中因发热导致的平均患病天数（AFD）从5.9±2.1天降至1.6±0.1天，而对照村庄则保持在5.0±1.0天。与对照村庄相比，实验山顶和山麓村庄的年发热发病率（AFI）有显著降低（p<0.05）。然而，年寄生虫发病率（API）的变化无统计学意义（p>0.05）。在低流行的平原村庄，实验村庄的AFI和API降低具有统计学意义（p<0.05）。与对照区相比，实验区高流行村庄在第2年和第3年期间寄生虫流行率有显著降低（p<0.05），但在低流行地区未观察到这种降低（p>0.05）。实验村庄中成年年龄组因疟疾导致的死亡率下降了75%，而对照村庄则呈上升趋势。
该研究表明，在部落地区由村庄志愿者运作的被动氯喹分发系统在降低疟疾相关的发病率和死亡率方面是可行且有效的。
