Programme National de Lutte contre le Paludisme, Niamey, Niger.
Malar J. 2012 Mar 27;11:89. doi: 10.1186/1475-2875-11-89.
The health authorities of Niger have implemented several malaria prevention and control programmes in recent years. These interventions broadly follow WHO guidelines and international recommendations and are based on interventions that have proved successful in other parts of Africa. Most performance indicators are satisfactory but, paradoxically, despite the mobilization of considerable human and financial resources, the malaria-fighting programme in Niger seems to have stalled, as it has not yet yielded the expected significant decrease in malaria burden. Indeed, the number of malaria cases reported by the National Health Information System has actually increased by a factor of five over the last decade, from about 600,000 in 2000 to about 3,000,000 in 2010. One of the weaknesses of the national reporting system is that the recording of malaria cases is still based on a presumptive diagnosis approach, which overestimates malaria incidence.
An extensive nationwide survey was carried out to determine by microscopy and RDT testing, the proportion of febrile patients consulting at health facilities for suspected malaria actually suffering from the disease, as a means of assessing the magnitude of this problem and obtaining a better estimate of malaria morbidity in Niger.
In total, 12,576 febrile patients were included in this study; 57% of the slides analysed were positive for the malaria parasite during the rainy season, when transmission rates are high, and 9% of the slides analysed were positive during the dry season, when transmission rates are lower. The replacement of microscopy methods by rapid diagnostic tests resulted in an even lower rate of confirmation, with only 42% of cases testing positive during the rainy season, and 4% during the dry season. Fever alone has a low predictive value, with a low specificity and sensitivity. These data highlight the absolute necessity of confirming all reported malaria cases by biological diagnosis methods, to increase the accuracy of the malaria indicators used in monitoring and evaluation processes and to improve patient care in the more remote areas of Niger. This country extends over a large range of latitudes, resulting in the existence of three major bioclimatic zones determining vector distribution and endemicity.
This survey showed that the number of cases of presumed malaria reported in health centres in Niger is largely overestimated. The results highlight inadequacies in the description of the malaria situation and disease risk in Niger, due to the over-diagnosis of malaria in patients with simple febrile illness. They point out the necessity of confirming all cases of suspected malaria by biological diagnosis methods and the need to take geographic constraints into account more effectively, to improve malaria control and to adapt the choice of diagnostic method to the epidemiological situation in the area concerned. Case confirmation will thus also require a change in behaviour, through the training of healthcare staff, the introduction of quality control, greater supervision of the integrated health centres, the implementation of good clinical practice and a general optimization of the use of available diagnostic methods.
尼日尔卫生当局近年来实施了几项疟疾预防和控制规划。这些干预措施大致遵循世卫组织的指导方针和国际建议，并基于在非洲其他地区证明有效的干预措施。大多数绩效指标令人满意，但矛盾的是，尽管调动了相当大的人力和财力资源，尼日尔的疟疾防治方案似乎已经停滞不前，因为它尚未产生预期的疟疾负担显著下降。事实上，国家卫生信息系统报告的疟疾病例数量在过去十年中实际上增加了五倍，从 2000 年的约 60 万例增加到 2010 年的约 300 万例。国家报告系统的一个弱点是，疟疾病例的记录仍基于推测性诊断方法，这种方法高估了疟疾的发病率。
进行了一次广泛的全国范围调查，通过显微镜检查和 RDT 检测，确定在卫生设施因疑似疟疾就诊的发热患者中实际患有该病的比例，以此评估这一问题的严重程度，并获得尼日尔疟疾发病率的更好估计。
共有 12576 例发热患者纳入本研究；在雨季（传播率高），分析的载玻片有 57%为疟原虫阳性，在旱季（传播率较低），分析的载玻片有 9%为疟原虫阳性。快速诊断检测替代显微镜方法导致确认率甚至更低，雨季有 42%的病例检测呈阳性，旱季有 4%的病例检测呈阳性。单纯发热的预测值较低，特异性和敏感性较低。这些数据突出表明，绝对有必要通过生物诊断方法确认所有报告的疟疾病例，以提高监测和评价过程中使用的疟疾指标的准确性，并改善尼日尔偏远地区的患者护理。该国幅员辽阔，纬度跨度大，存在三大生物气候带，决定了病媒的分布和流行程度。
这项调查显示，尼日尔卫生中心报告的疑似疟疾病例数量大大高估。结果突出表明，由于对单纯发热患者的疟疾过度诊断，尼日尔对疟疾情况和疾病风险的描述存在不足。结果还指出，有必要通过生物诊断方法确认所有疑似疟疾病例，并更有效地考虑到地理限制，以改善疟疾控制，并根据有关地区的流行病学情况选择诊断方法。因此，病例确认还需要通过医疗保健人员的培训、引入质量控制、加强对综合卫生中心的监督、实施良好的临床实践以及优化现有诊断方法的使用等方式来改变行为。
