Richards Adam K, Banek Kristin, Mullany Luke C, Lee Catherine I, Smith Linda, Oo Eh Kalu Shwe, Lee Thomas J
Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA 90024, USA.
Trop Med Int Health. 2009 May;14(5):512-21. doi: 10.1111/j.1365-3156.2009.02258.x. Epub 2009 Feb 24.
To document the feasibility of a cross-border community based integrated malaria control programme implemented by internally displaced persons in eastern Burma/Myanmar.
This pilot study was conducted from February 2003 through January 2005 in seven villages of displaced ethnic Karen. Interventions comprised early diagnosis of Plasmodium falciparum and treatment with mefloquine and artesunate, distribution of long-lasting insecticide treated nets (LLITNs), and educational messages. The primary outcome measure was P. falciparum prevalence during bi-annual universal screenings with the Paracheck-Pf (Orchid Biomedical Systems, Goa, India) device. Secondary outcomes were P. falciparum incidence and process indicators related to net use and malaria knowledge, attitudes and practices (KAP).
P. falciparum prevalence in original programme areas declined from 8.4% [95% confidence interval (CI) 8.3-8.6] at baseline to 1.1% (95% CI 1.1-1.2) in the final screening. Annual incidence in original areas declined from 232 to 70 cases/1000/year [incidence rate ratio 0.30 (95% CI 0.24-0.39)]. The proportion of household members sleeping under a LLITN improved from 0% to 89% and malaria KAP improved in all areas.
Integrated malaria control organized and implemented by displaced persons is feasible in eastern Burma/Myanmar. The decline in P. falciparum prevalence and incidence suggest that it may be possible to reduce the burden of disease and the reservoir of malaria in eastern Burma/Myanmar, with implications for malaria control in the greater Mekong region.
记录由缅甸东部境内流离失所者实施的基于社区的跨境疟疾综合防治项目的可行性。
这项试点研究于2003年2月至2005年1月在七个克伦族流离失所村庄进行。干预措施包括对恶性疟原虫进行早期诊断并用甲氟喹和青蒿琥酯进行治疗、分发长效驱虫蚊帐（LLITN）以及开展宣传教育。主要结局指标是使用Paracheck-Pf（印度果阿兰花生物医学系统公司）设备进行的半年一次全面筛查期间的恶性疟原虫流行率。次要结局指标是恶性疟原虫发病率以及与蚊帐使用和疟疾知识、态度及行为（KAP）相关的过程指标。
原项目地区的恶性疟原虫流行率从基线时的8.4%[95%置信区间（CI）8.3 - 8.6]降至最终筛查时的1.1%（95% CI 1.1 - 1.2）。原地区的年发病率从232例降至70例/1000/年[发病率比0.30（95% CI 0.24 - 0.39）]。睡在长效驱虫蚊帐下的家庭成员比例从0%提高到了89%，所有地区的疟疾知识、态度及行为均有所改善。
由流离失所者组织和实施的疟疾综合防治在缅甸东部是可行的。恶性疟原虫流行率和发病率的下降表明，有可能减轻缅甸东部的疾病负担和疟疾传染源，这对大湄公河地区的疟疾防治具有重要意义。
