National Institute for Medical Research - Amani Centre, Tanga, Tanzania.
Malar J. 2011 Oct 27;10:320. doi: 10.1186/1475-2875-10-320.
The annual incidence and temporal trend of severe malaria and community-acquired bacteraemia during a four-year period in Muheza, Tanzania was assessed.
Data on severely ill febrile children aged 2 months to 14 years from three prospective studies conducted at Muheza District Hospital from 2006 to 2010 was pooled and analysed. On admission, each enrolled child had a thin and thick blood film and at least one rapid diagnostic test for falciparum malaria, as well as a blood culture. The annual incidence of bacteraemia and severe malaria among children coming from Muheza was calculated and their temporal trend was assessed.
Overall, 1, 898 severe falciparum malaria and 684 bacteraemia cases were included. Of these, 1, 356 (71%) and 482 (71%), respectively, were from the referral population of Muheza. The incidence of falciparum malaria and all-cause bacteraemia in Muheza decreased five-fold and three-fold, respectively, from the first to the fourth year of surveillance (p < 0.0001). During this period, the median ages of children from Muheza admitted with severe malaria increased from 1.7 to 2.5 years (p < 0.0001). The reduction in all-cause bacteraemia was mainly driven by the 11-fold decline in the incidence of non-typhoidal salmonellosis. The annual incidences of Haemophilus influenzae and pneumococcal invasive bacterial infections decreased as well but were much fewer in number.
These results add to the growing evidence of the decline in malaria associated with a decrease in non-typhoidal salmonellosis and possibly other bacteraemias. Malarial prevention and control strategies may provide a greater benefit than the mere reduction of malaria alone.
在坦桑尼亚穆赫扎区医院进行的为期四年的三项前瞻性研究中，评估了严重疟疾和社区获得性菌血症的年发病率和时间趋势。
对 2006 年至 2010 年期间在穆赫扎区医院就诊的 2 个月至 14 岁严重发热儿童的数据进行了汇总和分析。每位入组儿童入院时均进行薄血膜和厚血膜检查，至少进行一种恶性疟原虫快速诊断检测，以及血培养。计算了来自穆赫扎的儿童细菌性血症和严重疟疾的年发病率，并评估了其时间趋势。
总共纳入了 1898 例严重恶性疟疾和 684 例菌血症病例，其中 1356 例（71%）和 482 例（71%）分别来自穆赫扎的转诊人群。从监测的第一年到第四年，恶性疟疾和所有原因菌血症的发病率分别下降了五倍和三倍（p<0.0001）。在此期间，来自穆赫扎的严重疟疾患儿的中位年龄从 1.7 岁增加到 2.5 岁（p<0.0001）。全因菌血症的减少主要是由于非伤寒沙门氏菌病发病率下降了 11 倍所致。流感嗜血杆菌和肺炎球菌侵袭性细菌感染的年发病率也有所下降，但数量要少得多。
这些结果增加了越来越多的证据，表明疟疾发病率的下降与非伤寒沙门氏菌病的减少以及其他可能的菌血症有关。疟疾预防和控制策略可能比单纯减少疟疾带来更大的益处。
