Greenwood B M
Medical Research Council Laboratories, Banjul, The Gambia.
Trans R Soc Trop Med Hyg. 1989;83 Suppl:25-9. doi: 10.1016/0035-9203(89)90599-3.
Recent studies in West Africa and in Papua New Guinea have shown that the prevalence of malaria can vary widely between neighbouring villages and within different parts of the same village. Both genetic and environmental factors are likely to contribute to these variations. Clustering in households of genetically determined red cell abnormalities, and possibly of immune response genes, may contribute to differences in the prevalence of malaria within a village. Environmental factors probably play the major part in explaining differences between villages. The position of a village in relation to mosquito breeding sites, the design of houses and the level at which anti-mosquito measures are used will all influence the degree to which its inhabitants are exposed to infection. Attitudes to the treatment of a case of malaria may also contribute to local variations in the prevalence of malaria. Malaria parasitaemia and splenomegaly will be less frequent in a community where effective treatment is given immediately at home, or sought promptly from a primary health care worker, than in a neighbouring community where there is a much greater reliance on traditional medicines. Recognition of local variations in the prevalence of malaria is important because identification of the factors responsible for a low prevalence in one village but a high one in a neighbouring community may indicate a possible control measure. Local variations in the epidemiology of malaria must also be taken into account when any kind of malaria intervention trial is planned.
最近在西非和巴布亚新几内亚开展的研究表明，疟疾的流行率在相邻村庄之间以及同一个村庄的不同区域之间可能存在很大差异。遗传因素和环境因素都可能导致这些差异。在家庭中，由基因决定的红细胞异常，以及可能的免疫反应基因的聚集，可能导致村庄内疟疾流行率的差异。环境因素可能在解释村庄之间的差异方面起主要作用。村庄相对于蚊子滋生地的位置、房屋设计以及防蚊措施的使用程度，都会影响居民接触感染的程度。对疟疾病例的治疗态度也可能导致疟疾流行率的局部差异。与邻近社区相比，如果一个社区能在家中立即进行有效治疗，或能迅速向初级卫生保健人员寻求治疗，那么该社区的疟疾寄生虫血症和脾肿大的发生率就会较低，而在邻近社区，人们对传统药物的依赖程度要高得多。认识到疟疾流行率的局部差异很重要，因为确定导致一个村庄疟疾流行率低而相邻社区疟疾流行率高的因素，可能会指明一种可行的控制措施。在规划任何类型的疟疾干预试验时，也必须考虑到疟疾流行病学的局部差异。
