Houngbedji Clarisse A, N'Dri Prisca B, Hürlimann Eveline, Yapi Richard B, Silué Kigbafori D, Soro Gotianwa, Koudou Benjamin G, Acka Cinthia A, Assi Serge-Brice, Vounatsou Penelope, N'Goran Eliézer K, Fantodji Agathe, Utzinger Jürg, Raso Giovanna
Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan 01, Côte d'Ivoire.
Malar J. 2015 Jan 5;14:7. doi: 10.1186/1475-2875-14-7.
There is limited knowledge on the malaria burden of school-aged children in Côte d'Ivoire. The aim of this study was to assess Plasmodium falciparum infection, malaria-related morbidity, use of preventive measures and treatment against malaria, and physical access to health structures among school-aged children across Côte d'Ivoire.
A national, cross-sectional study was designed, consisting of clinical and parasitological examinations and interviews with schoolchildren. More than 5,000 children from 93 schools in Côte d'Ivoire were interviewed to determine household socioeconomic status, self-reported morbidity and means of malaria prevention and treatment. Finger-prick blood samples were collected and Plasmodium infection and parasitaemia determined using Giemsa-stained blood films and a rapid diagnostic test (RDT). Haemoglobin levels and body temperature were measured. Children were classified into wealth quintiles using household assets and principal components analysis (PCA). The concentration index was employed to determine significant trends of health variables according to wealth quintiles. Logistic and binomial negative regression analyses were done to investigate for associations between P. falciparum prevalence and parasitaemia and any health-related variable.
The prevalence of P. falciparum was 73.9% according to combined microscopy and RDT results with a geometric mean of parasitaemia among infected children of 499 parasites/μl of blood. Infection with P. falciparum was significantly associated with sex, socioeconomic status and study setting, while parasitaemia was associated with age. The rate of bed net use was low compared to the rate of bed net ownership. Preventive measures (bed net ownership, insecticide spray and the reported use of malaria treatment) were more frequently mentioned by children from wealthier households who were at lower risk of P. falciparum infection. Self-reported morbidity (headache) and clinical morbidity (anaemia) were more often reported by children from less wealthy households.
Seven out of ten school-aged children in Côte d'Ivoire are infected with P. falciparum and malaria-related morbidity is considerable. Furthermore, this study points out that bed net usage is quite low and there are important inequalities in preventive measures and treatment. These results can guide equity-oriented malaria control strategies in Côte d'Ivoire.
关于科特迪瓦学龄儿童的疟疾负担，人们了解有限。本研究旨在评估科特迪瓦学龄儿童中的恶性疟原虫感染、疟疾相关发病率、预防措施和疟疾治疗的使用情况，以及获得医疗设施的实际情况。
设计了一项全国性横断面研究，包括对学童进行临床和寄生虫学检查及访谈。对科特迪瓦93所学校的5000多名儿童进行了访谈，以确定家庭社会经济状况、自我报告的发病率以及疟疾预防和治疗方法。采集手指血样，使用吉姆萨染色血涂片和快速诊断试验（RDT）确定疟原虫感染和寄生虫血症情况。测量血红蛋白水平和体温。使用家庭资产和主成分分析（PCA）将儿童分为五个财富五分位数。采用浓度指数根据财富五分位数确定健康变量的显著趋势。进行逻辑回归和二项式负回归分析，以研究恶性疟原虫患病率和寄生虫血症与任何健康相关变量之间的关联。
根据显微镜检查和RDT结果综合判断，恶性疟原虫患病率为73.9%，感染儿童的寄生虫血症几何平均值为每微升血液499个寄生虫。恶性疟原虫感染与性别、社会经济状况和研究地点显著相关，而寄生虫血症与年龄相关。与蚊帐拥有率相比，蚊帐使用率较低。较富裕家庭的儿童感染恶性疟原虫风险较低，他们更常提及预防措施（蚊帐拥有、杀虫剂喷洒以及报告的疟疾治疗使用情况）。较贫困家庭的儿童更常自我报告发病情况（头痛）和临床发病情况（贫血）。
科特迪瓦十分之七的学龄儿童感染了恶性疟原虫，疟疾相关发病率相当高。此外，本研究指出蚊帐使用率很低，在预防措施和治疗方面存在重大不平等。这些结果可为科特迪瓦以公平为导向的疟疾控制策略提供指导。
