Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan.
Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan ; Center for Global Child Health Hospital for Sick Children, Toronto, Canada.
Infect Dis Poverty. 2014 Aug 1;3:25. doi: 10.1186/2049-9957-3-25. eCollection 2014.
In this paper, we aim to evaluate the effectiveness of community-based interventions (CBIs) for the prevention and management of malaria. We conducted a systematic review and identified 42 studies for inclusion. Twenty-five of the included studies evaluated the impact of the community-based distribution of insecticide-treated nets (ITNs), indoor residual spraying (IRS), or impregnated bed sheets; 14 studies evaluated intermittent preventive therapy (IPT) delivered in community settings; two studies focused on community-based education for malaria prevention; and one study evaluated environmental management through drain cleaning. Our analysis suggests that, overall, the community-based delivery of interventions to prevent and control malaria resulted in a significant increase in ITNs ownership (RR: 2.16, 95% CI: 1.86, 2.52) and usage (RR: 1.77, 95% CI: 1.48, 2.11). However, usage of ITNs was limited to two-thirds of the population who owned them. Community-based strategies also led to a significant decrease in parasitemia (RR: 0.56, 95% CI: 0.42, 0.74), malaria prevalence (RR: 0.46, 95% CI: 0.29, 0.73), malaria incidence (RR: 0.70, 95% CI: 0.54, 0.90), and anemia prevalence (RR: 0.79, 95% CI: 0.64, 0.97). We found a non-significant impact on splenomegaly, birth outcomes (low birth weight, prematurity, stillbirth/miscarriage), anthropometric measures (stunting, wasting, and underweight), and mortality (all-cause and malaria-specific). The subgroup analysis suggested that community-based distribution of ITNs, impregnated bed sheets and IRS, and IPT are effective strategies. Qualitative synthesis suggests that high coverage could be achieved at a lower cost with the integration of CBIs with existing antenatal care and immunization campaigns. Community-based delivery of interventions to prevent and control malaria are effective strategies to improve coverage and access and reduce malaria burden, however, efforts should also be concerted to prevent over diagnosis and drug resistance.
本文旨在评估基于社区的干预措施（CBIs）在预防和管理疟疾方面的效果。我们进行了系统综述，共纳入了 42 项研究。其中 25 项研究评估了社区分发驱虫蚊帐（ITNs）、室内滞留喷洒（IRS）或浸渍床罩的影响；14 项研究评估了在社区环境中实施间歇性预防治疗（IPT）的效果；2 项研究关注疟疾预防的社区教育；1 项研究评估了通过清理排水沟进行环境管理。我们的分析表明，总体而言，社区提供干预措施以预防和控制疟疾，导致 ITNs 拥有率（RR：2.16，95%CI：1.86，2.52）和使用率（RR：1.77，95%CI：1.48，2.11）显著增加。然而，只有三分之二的 ITN 拥有者实际使用了这些蚊帐。基于社区的策略还显著降低了寄生虫血症（RR：0.56，95%CI：0.42，0.74）、疟疾患病率（RR：0.46，95%CI：0.29，0.73）、疟疾发病率（RR：0.70，95%CI：0.54，0.90）和贫血患病率（RR：0.79，95%CI：0.64，0.97）。我们发现，基于社区的策略对脾肿大、出生结局（低出生体重、早产、死胎/流产）、人体测量指标（发育迟缓、消瘦、体重不足）和死亡率（全因和疟疾特异性）没有显著影响。亚组分析表明，社区分发 ITNs、浸渍床罩和 IRS 以及 IPT 是有效的策略。定性综合分析表明，将 CBIs 与现有的产前护理和免疫接种运动相结合，可以以较低的成本实现高覆盖率。基于社区的干预措施在预防和控制疟疾方面是有效的策略，可以提高覆盖率和可及性，减轻疟疾负担，但也应努力防止过度诊断和耐药性的出现。
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