Malaria Public Health & Epidemiology Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
Malar J. 2010 Oct 30;9:306. doi: 10.1186/1475-2875-9-306.
To design and implement surveys of malaria infection and coverage of malaria control interventions among school children in Kenya in order to contribute towards a nationwide assessment of malaria.
The country was stratified into distinct malaria transmission zones based on a malaria risk map and 480 schools were visited between October 2008 and March 2010. Surveys were conducted in two phases: an initial opportunistic phase whereby schools were selected for other research purposes; and a second phase whereby schools were purposively selected to provide adequate spatial representation across the country. Consent for participation was based on passive, opt-out consent rather than written, opt-in consent because of the routine, low-risk nature of the survey. All children were diagnosed for Plasmodium infection using rapid diagnostic tests, assessed for anaemia and were interviewed about mosquito net usage, recent history of illness, and socio-economic and household indicators. Children's responses were entered electronically in the school and data transmitted nightly to Nairobi using a mobile phone modem connection. RDT positive results were corrected by microscopy and all results were adjusted for clustering using random effect regression modelling.
49,975 children in 480 schools were sampled, at an estimated cost of US$ 1,116 per school. The overall prevalence of malaria and anaemia was 4.3% and 14.1%, respectively, and 19.0% of children reported using an insecticide-treated net (ITN). The prevalence of infection showed marked variation across the country, with prevalence being highest in Western and Nyanza provinces, and lowest in Central, North Eastern and Eastern provinces. Nationally, 2.3% of schools had reported ITN use >60%, and low reported ITN use was a particular problem in Western and Nyanza provinces. Few schools reported having malaria health education materials or ongoing malaria control activities.
School malaria surveys provide a rapid, cheap and sustainable approach to malaria surveillance which can complement household surveys, and in Kenya, show that large areas of the country do not merit any direct school-based control, but school-based interventions, coupled with strengthened community-based strategies, are warranted in western and coastal Kenya. The results also provide detailed baseline data to inform evaluation of school-based malaria control in Kenya.
设计并实施肯尼亚在校学童疟疾感染和疟疾控制干预措施覆盖情况调查，以促进全国疟疾评估工作。
根据疟疾风险图，将该国划分为不同的疟疾传播区，2008 年 10 月至 2010 年 3 月期间共访问了 480 所学校。调查分两个阶段进行：第一阶段为机会性阶段，在该阶段根据其他研究目的选择学校；第二阶段为有针对性选择阶段，以便在全国范围内提供充分的空间代表性。由于调查的常规性和低风险性质，采用被动、退出式同意，而不是书面、选择加入式同意来获取参与同意。所有儿童均使用快速诊断检测进行疟原虫感染诊断，评估贫血情况，并通过访谈了解蚊帐使用情况、近期疾病史以及社会经济和家庭指标。儿童的回答通过电子方式输入学校，并使用移动电话调制解调器连接每晚将数据传输到内罗毕。使用显微镜纠正快速诊断检测阳性结果，并使用随机效应回归建模对所有结果进行聚类调整。
在 480 所学校中，对 49975 名儿童进行了抽样，估计每所学校的成本为 1116 美元。疟疾和贫血的总患病率分别为 4.3%和 14.1%，19.0%的儿童报告使用了经杀虫剂处理的蚊帐（ITN）。全国范围内的感染率存在明显差异，西部和尼安扎省的感染率最高，而中央、东北和东部省的感染率最低。全国范围内，有 2.3%的学校报告 ITN 使用比例>60%，而西部和尼安扎省的 ITN 报告使用比例较低。很少有学校报告拥有疟疾健康教育材料或正在开展疟疾控制活动。
学校疟疾调查为疟疾监测提供了一种快速、廉价且可持续的方法，可以补充家庭调查。在肯尼亚，调查结果表明该国大部分地区不需要任何直接的基于学校的控制，但在西部和沿海地区，需要开展基于学校的干预措施，并辅以强化的社区战略。调查结果还提供了详细的基线数据，为评估肯尼亚基于学校的疟疾控制措施提供了信息。
