Nygren David, Isaksson Arvid Lissel
Faculty of Medicine, Lund University , Sweden.
J Public Health Afr. 2014 Feb 4;5(1):171. doi: 10.4081/jphia.2014.171.
During the last decade much progress has been made in reducing malaria transmission in Macha, Southern Province, Zambia. Introduction of artemisinin combination therapies as well as mass screenings of asymptomatic carriers is believed to have contributed the most. When an endemic malaria situation is moving towards a non-endemic situation the resident population loses acquired immunity and therefore active case detection and efficient surveillance is crucial to prevent epidemic outbreaks. Our purpose was to evaluate the impact of cell phone surveillance and geographical information systems on malaria control in Macha. Furthermore, it evaluates what screening and treatment of asymptomatic carriers and implementation of rapid diagnostic tests in rural health care has led to. Ten in-depth semi-structured interviews, field observations and data collection were performed at the Macha Research Trust and at surrounding rural health centers. This qualitative method was inspired by rapid assessment procedure. The cell phone surveillance has been easily integrated in health care, and its integration with Geographical Information Systems has provided the ability to follow malaria transmission on a weekly basis. In addition, active case detection of asymptomatic carriers has been fruitful, which is reflected in it soon being applied nationwide. Furthermore, rapid diagnostic tests have provided rural health centers with reliable malaria diagnostics, thereby decreasing excessive malaria treatments and selection for drug resistance. This report reflects the importance of asymptomatic carriers in targeting malaria elimination, as well as development of effective surveillance systems when transmission decreases. Such an approach would be cost-efficient in the long run through positive effects in reduced child mortality and relief in health care.
在过去十年里，赞比亚南部省马查在减少疟疾传播方面取得了很大进展。青蒿素联合疗法的引入以及对无症状携带者的大规模筛查被认为贡献最大。当地方性疟疾状况朝着非地方性状况转变时，当地居民会失去获得性免疫力，因此主动病例检测和有效的监测对于预防疫情爆发至关重要。我们的目的是评估手机监测和地理信息系统对马查疟疾控制的影响。此外，还评估了对无症状携带者的筛查和治疗以及在农村医疗保健中实施快速诊断检测所带来的结果。在马查研究信托基金和周边农村医疗中心进行了十次深入的半结构化访谈、实地观察和数据收集。这种定性方法受到快速评估程序的启发。手机监测已很容易地融入医疗保健中，并且它与地理信息系统的整合使人们能够每周跟踪疟疾传播情况。此外，对无症状携带者的主动病例检测取得了成果，这体现在它很快在全国范围内得到应用。此外，快速诊断检测为农村医疗中心提供了可靠的疟疾诊断方法，从而减少了过度的疟疾治疗以及耐药性的产生。本报告反映了无症状携带者在实现疟疾消除目标方面的重要性，以及在传播减少时开发有效监测系统的重要性。从长远来看，这样一种方法通过降低儿童死亡率和减轻医疗保健负担的积极效果将具有成本效益。
