用于更好地利用常规卫生系统数据评估国家疟疾控制规划的方法框架：来自赞比亚的证据
A methodological framework for the improved use of routine health system data to evaluate national malaria control programs: evidence from Zambia.
作者信息
Bennett Adam, Yukich Joshua, Miller John M, Vounatsou Penelope, Hamainza Busiku, Ingwe Mercy M, Moonga Hawela B, Kamuliwo Mulakwo, Keating Joseph, Smith Thomas A, Steketee Richard W, Eisele Thomas P
机构信息
Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th St, San Francisco, CA 94143 USA ; Center for Applied Malaria Research and Evaluation, Tulane University of Public Health and Tropical Medicine, 1440 Canal St., Suite 2200, New Orleans, LA 70112 USA.
Center for Applied Malaria Research and Evaluation, Tulane University of Public Health and Tropical Medicine, 1440 Canal St., Suite 2200, New Orleans, LA 70112 USA.
出版信息
Popul Health Metr. 2014 Nov 19;12(1):30. doi: 10.1186/s12963-014-0030-0. eCollection 2014.
BACKGROUND
Due to challenges in laboratory confirmation, reporting completeness, timeliness, and health access, routine incidence data from health management information systems (HMIS) have rarely been used for the rigorous evaluation of malaria control program scale-up in Africa.
METHODS
We used data from the Zambia HMIS for 2009-2011, a period of rapid diagnostic and reporting scale-up, to evaluate the association between insecticide-treated net (ITN) program intensity and district-level monthly confirmed outpatient malaria incidence using a dose-response national platform approach with district-time units as the unit of analysis. A Bayesian geostatistical model was employed to estimate longitudinal district-level ITN coverage from household survey and programmatic data, and a conditional autoregressive model (CAR) was used to impute missing HMIS data. The association between confirmed malaria case incidence and ITN program intensity was modeled while controlling for known confounding factors, including climate variability, reporting, testing, treatment-seeking, and access to health care, and additionally accounting for spatial and temporal autocorrelation.
RESULTS
An increase in district level ITN coverage of one ITN per household was associated with an estimated 27% reduction in confirmed case incidence overall (incidence rate ratio (IRR): 0 · 73, 95% Bayesian Credible Interval (BCI): 0 · 65-0 · 81), and a 41% reduction in areas of lower malaria burden.
CONCLUSIONS
When improved through comprehensive parasitologically confirmed case reporting, HMIS data can become a valuable tool for evaluating malaria program scale-up. Using this approach we provide further evidence that increased ITN coverage is associated with decreased malaria morbidity and use of health services for malaria illness in Zambia. These methods and results are broadly relevant for malaria program evaluations currently ongoing in sub-Saharan Africa, especially as routine confirmed case data improve.
背景
由于实验室确诊、报告完整性、及时性以及医疗可及性方面存在挑战，非洲卫生管理信息系统（HMIS）的常规发病率数据很少用于对疟疾控制项目扩大规模进行严格评估。
方法
我们使用了赞比亚卫生管理信息系统2009 - 2011年的数据，这是快速诊断和报告规模扩大的时期，采用以地区时间单位为分析单位的剂量反应国家平台方法，评估经杀虫剂处理蚊帐（ITN）项目强度与地区层面每月确诊门诊疟疾发病率之间的关联。采用贝叶斯地理统计模型根据家庭调查和项目数据估计地区层面ITN的纵向覆盖率，并使用条件自回归模型（CAR）对缺失的卫生管理信息系统数据进行插补。在控制已知混杂因素（包括气候变异性、报告、检测、寻求治疗以及获得医疗服务）的同时，对确诊疟疾病例发病率与ITN项目强度之间的关联进行建模，并另外考虑空间和时间自相关性。
结果
地区层面每户ITN覆盖率每增加一个，总体确诊病例发病率估计降低27%（发病率比（IRR）：0.73，95%贝叶斯可信区间（BCI）：0.65 - 0.81），在疟疾负担较低地区降低41%。
结论
通过全面的寄生虫学确诊病例报告加以改进后，卫生管理信息系统数据可成为评估疟疾项目扩大规模的宝贵工具。采用这种方法，我们进一步证明，在赞比亚，ITN覆盖率增加与疟疾发病率降低以及因疟疾疾病使用卫生服务减少相关。这些方法和结果与撒哈拉以南非洲目前正在进行的疟疾项目评估广泛相关，特别是随着常规确诊病例数据的改善。
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