乌干达维多利亚湖湖滨和岛屿社区血吸虫病、土壤传播性蠕虫病和疟疾综合流行情况绘图。

BACKGROUND

It is widely advocated that integrated strategies for the control of neglected tropical diseases (NTDs) are cost-effective in comparison to vertical disease-specific programmes. A prerequisite for implementation of control interventions is the availability of baseline data of prevalence, including the population at risk and disease overlap. Despite extensive literature on the distribution of schistosomiasis on the mainland in Uganda, there has been a knowledge gap for the prevalence of co-infections with malaria, particularly for island communities in Lake Victoria. In this study, nine lakeshore and island districts were surveyed for the prevalence of NTDs and malaria, as well as educational and health infrastructure.

RESULTS

A total of 203 communities were surveyed, including over 5000 school-age children. Varying levels of existing health infrastructure were observed between districts, with only Jinja District regularly treating people for NTDs. Community medicine distributors (CMD) were identified and trained in drug delivery to strengthen capacity. Prevalence levels of intestinal schistosomiasis and soil-transmitted helminthiasis were assessed via Kato-Katz thick smears of stool and malaria prevalence determined by microscopy of fingerprick blood samples. Prevalence levels were 40.8%, 26.04% and 46.4%, respectively, while the prevalence of co-infection by Schistosoma mansoni and Plasmodium spp. was 23.5%. Socio-economic status was strongly associated as a risk factor for positive infection status with one or more of these diseases.

CONCLUSIONS

These results emphasise the challenges of providing wide-scale coverage of health infrastructure and drug distribution in remote lakeshore communities. The data further indicate that co-infections with malaria and NTDs are common, implying that integrated interventions for NTDs and malaria are likely to maximize cost-effectiveness and sustainability of disease control efforts.

背景

与针对特定疾病的垂直方案相比，控制被忽视的热带病（NTDs）的综合策略被广泛认为具有成本效益。实施控制干预的前提是具备流行率的基线数据，包括受威胁人口和疾病重叠情况。尽管乌干达大陆上有关血吸虫病分布的文献很多，但对于疟疾的合并感染（特别是维多利亚湖岛屿社区）的流行率仍存在知识空白。在这项研究中，对 9 个湖滨和岛屿地区进行了 NTD 和疟疾以及教育和卫生基础设施的流行率调查。

结果

共调查了 203 个社区，包括 5000 多名学龄儿童。不同地区之间观察到现有的卫生基础设施水平存在差异，只有 Jinja 区定期为 NTD 患者提供治疗。确定了社区医药分销商（CMD）并对其进行了药物配送培训，以加强能力。通过粪便厚涂片的 Kato-Katz 法评估肠道血吸虫病和土壤传播性蠕虫病的流行率，并通过手指采血样的显微镜检查确定疟疾的流行率。分别为 40.8％，26.04％和 46.4％，而曼氏血吸虫和疟原虫属的合并感染率为 23.5％。社会经济地位是感染这些疾病之一或多种疾病的重要危险因素。