1999 年至 2008 年肯尼亚儿科疟疾住院治疗情况。

BACKGROUND: Intervention coverage and funding for the control of malaria in Africa has increased in recent years, however, there are few descriptions of changing disease burden and the few reports available are from isolated, single site observations or are of reports at country-level. Here we present a nationwide assessment of changes over 10 years in paediatric malaria hospitalization across Kenya. METHODS: Paediatric admission data on malaria and non-malaria diagnoses were assembled for the period 1999 to 2008 from in-patient registers at 17 district hospitals in Kenya and represented the diverse malaria ecology of the country. These data were then analysed using autoregressive moving average time series models with malaria and all-cause admissions as the main outcomes adjusted for rainfall, changes in service use and populations-at-risk within each hospital's catchment to establish whether there has been a statistically significant decline in paediatric malaria hospitalization during the observation period. RESULTS: Among the 17 hospital sites, adjusted paediatric malaria admissions had significantly declined at 10 hospitals over 10 years since 1999; had significantly increased at four hospitals, and remained unchanged in three hospitals. The overall estimated average reduction in malaria admission rates was 0.0063 cases per 1,000 children aged 0 to 14 years per month representing an average percentage reduction of 49% across the 10 hospitals registering a significant decline by the end of 2008. Paediatric admissions for all-causes had declined significantly with a reduction in admission rates of greater than 0.0050 cases per 1,000 children aged 0 to 14 years per month at 6 of 17 hospitals. Where malaria admissions had increased three of the four sites were located in Western Kenya close to Lake Victoria. Conversely there was an indication that areas with the largest declines in malaria admission rates were areas located along the Kenyan coast and some sites in the highlands of Kenya. CONCLUSION: A country-wide assessment of trends in malaria hospitalizations indicates that all is not equal, important variations exist in the temporal pattern of malaria admissions between sites and these differences require more detailed investigation to understand what is required to promote a clinical transition across Africa.

背景：近年来，非洲疟疾控制的干预措施覆盖范围和资金有所增加，然而，关于疾病负担变化的描述却很少，而且现有的少数报告来自孤立的单一地点观察或国家层面的报告。在这里，我们对肯尼亚 10 年来儿科疟疾住院情况的变化进行了全国性评估。

方法：从肯尼亚 17 家地区医院的住院患者登记处收集了 1999 年至 2008 年期间儿科疟疾和非疟疾诊断的数据，这些数据代表了该国多样化的疟疾生态。然后，使用自回归移动平均时间序列模型对这些数据进行分析，以疟疾和全因入院为主要结果，调整每个医院集水区内的降雨量、服务利用变化和高危人群，以确定在观察期间儿科疟疾住院是否有统计学意义的下降。

结果：在 17 个医院中，在 1999 年以来的 10 年中，有 10 家医院的调整后儿科疟疾入院率显著下降；4 家医院的入院率显著上升，3 家医院的入院率保持不变。疟疾入院率的总体估计平均下降率为每 1000 名 0 至 14 岁儿童每月 0.0063 例，代表 10 家登记有显著下降的医院的平均百分比下降 49%，到 2008 年底。所有原因的儿科入院率均显著下降，17 家医院中有 6 家的 0 至 14 岁儿童每月每 1000 人入院率下降超过 0.0050 例。疟疾入院率上升的 4 家医院中有 3 家位于靠近维多利亚湖的肯尼亚西部。相反，表明疟疾入院率下降最大的地区是肯尼亚沿海地区和肯尼亚高地的一些地区。

结论：对疟疾住院趋势的全国性评估表明，情况并非如此，各地区之间疟疾入院的时间模式存在重要差异，需要更详细的调查来了解需要采取哪些措施来促进非洲的临床转变。