孟加拉国的疟疾负担和控制状况及消除前景：一项流行病学和经济评估。

Malaria burden and control in Bangladesh and prospects for elimination: an epidemiological and economic assessment.

机构信息

W Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

Department of Mathematical Sciences and Technology, Norwegian University of Life Sciences, Ås, Norway.

出版信息

Lancet Glob Health. 2014 Feb;2(2):e98-105. doi: 10.1016/S2214-109X(13)70176-1. Epub 2014 Jan 23.

DOI:10.1016/S2214-109X(13)70176-1

PMID:25104666

Abstract

BACKGROUND

Malaria is endemic in 13 of 64 districts in Bangladesh. About 14 million people are at risk. Some evidence suggests that the prevalence of malaria in Bangladesh has decreased since the the Global Fund to Fight AIDS, Tuberculosis and Malaria started to support the National Malaria Control Program (NMCP) in 2007. We did an epidemiological and economic assessment of malaria control in Bangladesh.

METHODS

We obtained annually reported, district-level aggregated malaria case data and information about disbursed funds from the NMCP. We used a Poisson regression model to examine the associations between total malaria, severe malaria, malaria-attributable mortality, and insecticide-treated net coverage. We identified and mapped malaria hotspots using the Getis-Ord Gi* statistic. We estimated the cost-effectiveness of the NMCP by estimating the cost per confirmed case, cost per treated case, and cost per person of insecticide-treated net coverage.

FINDINGS

During the study period (from Jan 1, 2008, to Dec 31, 2012) there were 285,731 confirmed malaria cases. Malaria decreased from 6.2 cases per 1000 population in 2008, to 2.1 cases per 1000 population in 2012. Prevalence of all malaria decreased by 65% (95% CI 65-66), severe malaria decreased by 79% (78-80), and malaria-associated mortality decreased by 91% (83-95). By 2012, there was one insecticide-treated net for every 2.6 individuals (SD 0.20). Districts with more than 0.5 insecticide-treated nets per person had a decrease in prevalence of 21% (95% CI 19-23) for all malaria, 25% (17-32) for severe malaria, and 76% (35-91) for malaria-associated mortality among all age groups. Malaria hotspots remained in the highly endemic districts in the Chittagong Hill Tracts. The cost per diagnosed case was US$0.39 (SD 0.02) and per treated case was $0.51 (0.27); $0.05 (0.04) was invested per person per year for health education and $0.68 (0.30) was spent per person per year for insecticide-treated net coverage.

INTERPRETATION

Malaria elimination is an achievable prospect in Bangladesh and failure to push for elimination nearly ensures a resurgence of disease. Consistent financing is needed to avoid resurgence and maintain elimination goals.

FUNDING

None.

摘要

背景

疟疾在孟加拉国 64 个区中的 13 个区流行。约有 1400 万人面临风险。有证据表明，自全球抗击艾滋病、结核病和疟疾基金于 2007 年开始支持国家疟疾控制规划以来，孟加拉国的疟疾发病率有所下降。我们对孟加拉国的疟疾控制进行了流行病学和经济评估。

方法

我们从国家疟疾控制规划中获得了每年报告的、按区汇总的疟疾病例数据和有关资金拨付的信息。我们使用泊松回归模型来检验总疟疾、重症疟疾、疟疾相关死亡和经杀虫剂处理的蚊帐覆盖率之间的关联。我们使用 Getis-Ord Gi*统计数据确定和绘制疟疾热点图。我们通过估计确诊病例的成本、治疗病例的成本以及每人使用经杀虫剂处理的蚊帐的成本来估算国家疟疾控制规划的成本效益。

结果

在研究期间（2008 年 1 月 1 日至 2012 年 12 月 31 日），共有 285731 例确诊疟疾病例。疟疾从 2008 年每 1000 人 6.2 例下降到 2012 年每 1000 人 2.1 例。所有疟疾的患病率下降了 65%（95%CI 65-66），重症疟疾下降了 79%（78-80），疟疾相关死亡率下降了 91%（83-95）。到 2012 年，每 2.6 人就有一张经杀虫剂处理的蚊帐（SD 0.20）。人均拥有超过 0.5 顶经杀虫剂处理的蚊帐的地区，所有疟疾的患病率下降了 21%（95%CI 19-23），重症疟疾下降了 25%（17-32），所有年龄组的疟疾相关死亡率下降了 76%（35-91）。疟疾热点仍然存在于吉大港山区高度流行的地区。每例确诊病例的成本为 0.39 美元（0.02 美元），每例治疗病例的成本为 0.51 美元（0.27 美元）；每年每人用于健康教育的投资为 0.05 美元（0.04 美元），每年每人用于经杀虫剂处理的蚊帐覆盖的支出为 0.68 美元（0.30 美元）。