在城市环境中增加大规模药物治疗以消除淋巴丝虫病的覆盖范围：肯尼亚马林迪镇的一项研究。
Increasing coverage in mass drug administration for lymphatic filariasis elimination in an urban setting: a study of Malindi Town, Kenya.
机构信息
Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya.
出版信息
PLoS One. 2014 Jan 14;9(1):e83413. doi: 10.1371/journal.pone.0083413. eCollection 2014.
INTRODUCTION
Implementation of Mass Drug Administration (MDA) in urban settings is an obstacle to Lymphatic Filariasis (LF) elimination. No urban-specific guidelines on MDA in urban areas exist. Malindi district urban area had received 4 MDA rounds by the time the current study was implemented. Programme data showed average treatment coverage of 28.4% (2011 MDA), far below recommended minimum of 65-80%.
METHODS
To identify, design and test strategies for increased treatment coverage in urban areas, a quasi-experimental study was conducted in Malindi urban area. Three sub-locations with lowest treatment coverage in 2011 MDA were purposively selected. In the pre-test phase, 947 household heads sampled using systematic random method were interviewed for quantitative data. For qualitative data, 12 Focus Group Discussions (FGDs) with single sex adult and youth male and female groups and 3 with community drug distributors (CDDs) were conducted. Forty in-depth interviews with opinion leaders and self-administered questionnaires with District Public Health officers purposively selected were carried out. The quantitative data were analyzed using SPSS version 16 and statistical significance assessed by χ(2) test.The qualitative data were analyzed manually according to study's themes.
RESULTS AND DISCUSSION
The identified strategies were implemented prior to and during 2012 MDA in two sub-locations (experimental) while in the third (control), usual MDA strategies were applied. In the post-test phase, 2012 MDA coverage in experimental and control sub-locations was comparatively assessed for effect of the newly designed strategies on urban MDA. Results indicated improved treatment coverage in experimental sub-locations, 77.1% in Shella and 66.0% in Barani. Central (control) sub-location also attained high coverage, 70.4% indicating average treatment coverage of 71%.
CONCLUSION
The identified strategies contributed to increased treatment coverage in experimental sites and should be applied in urban areas. Due to closeness of sites, spillover effects may have contributed to increased coverage in the control site.
引言
在城市环境中实施大规模药物治疗（MDA）是淋巴丝虫病（LF）消除的一个障碍。目前还没有针对城市地区 MDA 的专门城市指南。在当前研究实施时，马林迪区城区已经接受了四轮 MDA。项目数据显示，平均治疗覆盖率为 28.4%（2011 年 MDA），远低于建议的 65-80%的最低要求。
方法
为了确定、设计和测试提高城市地区治疗覆盖率的策略，在马林迪城区进行了一项准实验研究。有针对性地选择了 2011 年 MDA 治疗覆盖率最低的三个分地点。在预测试阶段，采用系统随机抽样方法抽取了 947 户家庭户主进行定量数据访谈。对于定性数据，与单性别的成年男女和青年男女各进行了 12 次焦点小组讨论（FGD），与社区药物分销商（CDD）进行了 3 次讨论。对有影响力的人进行了 40 次深入访谈，并对区公共卫生官员进行了有针对性的自我管理问卷调查。使用 SPSS 版本 16 对定量数据进行分析，并通过 χ(2)检验评估统计显著性。根据研究主题手动分析定性数据。
结果与讨论
在所确定的策略中，有针对性地在两个分地点（实验组）实施了 2012 年 MDA 之前和期间的策略，而在第三个分地点（对照组）则应用了通常的 MDA 策略。在测试阶段，对实验组和对照组分地点 2012 年 MDA 覆盖率进行了评估，以评估新设计的策略对城市 MDA 的影响。结果表明，实验组治疗覆盖率有所提高，谢拉为 77.1%，巴兰尼为 66.0%。中心（对照组）分地点也实现了高覆盖率，为 70.4%，表明平均治疗覆盖率为 71%。
结论
所确定的策略有助于提高实验组的治疗覆盖率，应在城市地区应用。由于地点相近，可能存在溢出效应，导致对照组覆盖率提高。
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