Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, KEMRI-University of Oxford-Wellcome Trust Collaborative Programme, Kenyatta National Hospital Grounds, Nairobi, Kenya.
BMC Public Health. 2009 Oct 1;9:369. doi: 10.1186/1471-2458-9-369.
The scaling of malaria control to achieve universal coverage requires a better understanding of the population sub-groups that are least protected and provide barriers to interrupted transmission. Here we examine the age pattern of use of insecticide treated nets (ITNs) in Africa in relation to biological vulnerabilities and the implications for future prospects for universal coverage.
Recent national household survey data for 18 malaria endemic countries in Africa were assembled to identify information on use of ITNs by age and sex. Age-structured medium variant projected population estimates for the mid-point year of the earliest and most recent national surveys were derived to compute the population by age protected by ITNs.
All surveys were undertaken between 2005 and 2009, either as demographic health surveys (n = 12) or malaria indicator surveys (n = 6). Countries were categorized into three ITN use groups: <10%; 10 to <20%; and > or =20% and projected population estimates for the mid-point year of 2007 were computed. In general, the pattern of overall ITNs use with age was similar by country and across the three country groups with ITNs use initially high among children <5 years of age, sharply declining among the population aged 5-19 years, before rising again across the ages 20-44 years and finally decreasing gradually in older ages. For all groups of countries, the highest proportion of the population not protected by ITNs (38% - 42%) was among those aged 5-19 years.
In malaria-endemic Africa, school-aged children are the least protected with ITNs but represent the greatest reservoir of infections. With increasing school enrollment rates, school-delivery of ITNs should be considered as an approach to reach universal ITNs coverage and improve the likelihood of impacting upon parasite transmission.
为实现疟疾防控的普及，我们需要更好地了解保护程度最低的人群亚组，并找到阻碍疟疾传播中断的因素。本研究旨在分析非洲地区人群使用驱虫蚊帐（ITN）的年龄模式与生物易感性之间的关系，以及对未来实现普及覆盖的影响。
我们收集了 18 个非洲疟疾流行国家最近的全国家庭调查数据，以确定按年龄和性别划分的 ITN 使用信息。从中提取最早和最近的国家调查中点年份的年龄结构的中变异预测人口估计值，以计算按年龄分组的 ITN 保护人群。
所有调查均在 2005 年至 2009 年间进行，调查类型包括人口与健康调查（n = 12）和疟疾指标调查（n = 6）。根据 ITN 使用比例，我们将这些国家分为三组：<10%；10%至<20%；以及>或=20%。并计算了 2007 年中点年份的预测人口估计值。总体而言，各国的 ITN 使用模式与年龄的关系相似，并且在三个国家组中均呈现出一致的趋势：儿童（<5 岁）中 ITN 的使用率较高，5-19 岁人群的使用率急剧下降，然后在 20-44 岁年龄段再次上升，最后在老年人群中逐渐下降。在所有国家组中，未使用 ITN 的人群中比例最高（38%-42%）的是 5-19 岁的人群。
在疟疾流行的非洲地区，学龄儿童的 ITN 保护程度最低，但他们也是感染的最大传染源。随着入学率的提高，应考虑通过学校发放 ITN 的方式来实现普及 ITN 覆盖，从而提高对寄生虫传播的影响。
