Bizimana Jean-Pierre, Twarabamenye Emmanuel, Kienberger Stefan
College of Science and Technology, Geography Department, University of Rwanda, PO Box 212, Butare, Rwanda.
Malar J. 2015 Jan 7;14:2. doi: 10.1186/1475-2875-14-2.
Since 2004, malaria interventions in Rwanda have resulted in substantial decline of malaria incidence. However, this achievement is fragile as potentials for local malaria transmissions remain. The risk of getting malaria infection is partially explained by social conditions of vulnerable populations. Since vulnerability to malaria is both influenced by social and environmental factors, its complexity cannot be measured by a single value. The aim of this paper is, therefore, to apply a composite indicator approach for assessing social vulnerability to malaria in Rwanda. This assessment informs the decision-makers in targeting malaria interventions and allocating limited resources to reduce malaria burden in Rwanda.
A literature review was used to conceptualize the social vulnerability to malaria and to select the appropriate vulnerability indicators. Indicators used in the index creation were classified into susceptibility and lack of resilience vulnerability domains. The main steps followed include selection of indicators and datasets, imputation of missing values, descriptive statistics, normalization and weighting of indicators, local sensitivity analysis and indicators aggregation. Correlation analysis helped to empirically evidence the association between the indicators and malaria incidence.
The high values of social vulnerability to malaria are found in Gicumbi, Rusizi, Nyaruguru and Gisagara, and low values in Muhanga, Nyarugenge, Kicukiro and Nyanza. The most influential susceptibility indicators to increase malaria are population change (r = 0.729), average number of persons per bedroom (r = 0.531), number of households affected by droughts and famines (r = 0.591), and area used for irrigation (r = 0.611). The bed net ownership (r = -0.398) and poor housing wall materials (0.378) are the lack of resilience indicators that significantly correlate with malaria incidence.
The developed composite index social vulnerability to malaria indicates which indicators need to be addressed and in which districts. The results from this study are salient for public health policy- and decision makers in malaria control in Rwanda and timely support the national integrated malaria initiative. Future research development should focus on spatial explicit vulnerability assessment by combining environmental and social drivers to achieve an integrated and complete assessment of vulnerability to malaria.
自2004年以来，卢旺达的疟疾干预措施已使疟疾发病率大幅下降。然而，这一成果并不稳固，因为当地疟疾传播的可能性依然存在。弱势群体的社会状况在一定程度上解释了感染疟疾的风险。由于对疟疾的易感性受到社会和环境因素的双重影响，其复杂性无法用单一数值来衡量。因此，本文旨在应用综合指标法评估卢旺达社会对疟疾的脆弱性。这一评估可为决策者在确定疟疾干预目标以及分配有限资源以减轻卢旺达疟疾负担方面提供参考。
通过文献综述来界定社会对疟疾的脆弱性并选择合适的脆弱性指标。构建指数时使用的指标分为易感性和缺乏恢复力的脆弱性领域。主要步骤包括指标和数据集的选择、缺失值插补、描述性统计、指标的标准化和加权、局部敏感性分析以及指标汇总。相关性分析有助于从实证角度证明指标与疟疾发病率之间的关联。
基孔比、鲁西齐、尼亚鲁古鲁和吉萨加拉的社会对疟疾的脆弱性值较高，而穆汉加、尼亚鲁根杰、基库基罗和尼亚扎的值较低。增加疟疾易感性的最具影响力的指标是人口变化（r = 0.729）、每间卧室平均人数（r = 0.531）、受干旱和饥荒影响的家庭数量（r = 0.591）以及灌溉面积（r = 0.611）。蚊帐拥有率（r = -0.398）和劣质住房墙体材料（0.378）是与疟疾发病率显著相关的缺乏恢复力的指标。
所构建的社会对疟疾的脆弱性综合指数表明了哪些指标以及哪些地区需要加以关注。本研究结果对卢旺达疟疾控制方面的公共卫生政策制定者和决策者具有重要意义，并及时为国家综合疟疾倡议提供支持。未来的研究发展应侧重于通过结合环境和社会驱动因素进行空间明确的脆弱性评估，以实现对疟疾脆弱性的综合全面评估。
