Wanzira Humphrey, Katamba Henry, Okullo Allen Eva, Agaba Bosco, Kasule Mathias, Rubahika Denis
National Malaria Control Programme, Ministry of Health, Kampala, Uganda.
Makerere University, School of Public Health, Fellowship Programme, Kampala, Uganda.
Malar J. 2017 May 8;16(1):191. doi: 10.1186/s12936-017-1847-3.
In the midst of success with malaria reduction in Uganda, there are areas that still have high prevalence of malaria parasitaemia. This project aimed at investigating factors associated with this prevalence and its relationship with anaemia.
This is a secondary data analysis of the 2014 Malaria Indicator Survey dataset of children under 5 years. All had a blood sample taken by finger or heel prick for determination of malaria parasitaemia and estimation of haemoglobin level for anaemia status. The main outcome was the presence of malaria parasitaemia by microscopy and independent variables included: age, gender, residence (urban vs rural), use of a long-lasting, insecticidal-treated net, indoor residual spraying (IRS) of household in the past 6 months, mother's highest education level, mother heard malaria prevention message in the past 6 months, and household wealth status.
The analysis included 4930 children and of these, 938 (19.04%: 95% CI 16.63-21.71) tested positive for malaria parasites. Malaria parasite prevalence significantly increased from 11.08 (95% CI 9.12-13.40) among children with no anaemia to 50.99% (95% CI 39.13-62.74) with severe anaemia (Chi-square p-value = 0.001). Additionally, prevalence significantly rose from the youngest age group (under 6 months) by 1.62 times (95% CI 1.04-2.52, p = 0.033) among the age group of 7-12 months and to four times (95% CI 2.57-6.45, p = 0.001) among those who were between 49 and 59 months. The following were associated with reduced parasitaemia: IRS use (AOR 0.23 [0.08-0.61], p = 0.004), educated mothers (primary AOR 0.75 [0.59-0.96], p = 0.023 to tertiary AOR 0.11 [0.02-0.53], 0.006), mother heard malaria message (AOR 0.78 [0.62-0.99], p = 0.037), and wealthier households (richest AOR 0.17 [0.08-0.36], p = 0.001).
Increasing malaria parasite prevalence among children under 5 years is still related to increasing age and severity of anaemia even in the context of decreasing malaria prevalence. Designing interventions that include the use of IRS and behaviour change communication tailored to include older children, especially in areas with high malaria prevalence, could be of added value. All this should be done in an environment that improves the socio-economic status and equity of such populations.
在乌干达疟疾防治取得成效的同时，仍有一些地区疟疾寄生虫血症的患病率很高。本项目旨在调查与此患病率相关的因素及其与贫血的关系。
这是对2014年5岁以下儿童疟疾指标调查数据集的二次数据分析。所有儿童均通过手指或足跟采血获取血样，以确定疟疾寄生虫血症，并估算血红蛋白水平以评估贫血状况。主要结果是通过显微镜检查发现疟疾寄生虫血症，自变量包括：年龄、性别、居住地（城市与农村）、使用长效驱虫蚊帐、过去6个月内家庭进行室内滞留喷洒（IRS）、母亲的最高教育水平、母亲在过去6个月内是否听过疟疾预防信息以及家庭财富状况。
分析纳入了4930名儿童，其中938名（19.04%：95%置信区间16.63 - 21.71）疟疾寄生虫检测呈阳性。疟疾寄生虫患病率从无贫血儿童中的11.08%（95%置信区间9.12 - 13.40）显著升至重度贫血儿童中的50.99%（95%置信区间39.13 - 62.74）（卡方检验p值 = 0.001）。此外，患病率从最年幼年龄组（6个月以下）开始显著上升，7至12个月年龄组上升了1.62倍（95%置信区间1.04 - 2.52，p = 0.033），49至59个月年龄组上升至4倍（95%置信区间2.57 - 6.45，p = 0.001）。以下因素与寄生虫血症减少相关：使用IRS（调整优势比0.23 [0.08 - 0.61]，p = 0.004）、母亲受过教育（小学调整优势比0.75 [0.59 - 0.96]，p = 0.023；大专调整优势比0.11 [0.02 - 0.53]，p = 0.006）、母亲听过疟疾信息（调整优势比0.78 [0.62 - 0.99]，p = 0.037）以及富裕家庭（最富裕调整优势比0.17 [0.08 - 0.36]，p = 0.001）。
即使在疟疾患病率下降的情况下，5岁以下儿童中疟疾寄生虫患病率的增加仍与年龄增长和贫血严重程度增加有关。设计包括使用IRS以及针对大龄儿童进行行为改变沟通的干预措施，尤其是在疟疾高流行地区，可能会有附加价值。所有这些都应在改善此类人群社会经济地位和平等性的环境中进行。
