Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Pu'er City, China.
Laiza City Hospital, Laiza City, Kachin Special Region II, Myanmar.
PLoS One. 2018 Apr 3;13(4):e0195032. doi: 10.1371/journal.pone.0195032. eCollection 2018.
Although drug-based treatment is the primary intervention for malaria control and elimination, optimal use of targeted treatments remains unclear. From 2008 to 2016, three targeted programs on treatment were undertaken in Kachin Special Region II (KR2), Myanmar. Program I (2008-2011) treated all confirmed, clinical and suspected cases; program II (2012-2013) treated confirmed and clinical cases; and program III (2014-2016) targeted confirmed cases only. This study aims to evaluate the impacts of the three programs on malaria burden individually based on the annual parasite incidence (API), slide positivity rate (SPR) and their relative values. The API is calculated from original collected data and the incidence rate ratio (IRR) for each year is calculated by using the first-year API as a reference in each program phase across the KR2. Same method is applied to calculate SPR and risk ratio (RR) at the sentinel hospital too. During program I (2008-2011), malaria burden was reduced by 61% (95%CI: 58%-74%) and the actual API decreased from 9.8 (95%CI: 9.6-10.1) per 100 person-years in 2008 to 3.8 (3.6-4.1) per 100 person-years in 2011. Amid program II (2012-2013), the malaria burden increased by 33% (95%CI: 22%-46%) and the actual API increased from 2.1(95%CI: 2.0-2.3) per 100 person-years in 2012 to 2.8 (95%CI: 2.7-2.9) per 100 person-years in 2013. During program III (2014-2016) the malaria burden increased furtherly by 60% (95%CI: 51% - 69%) and the actual API increased from 3.2(95%CI: 3.0-3.3) per 100 person-years in 2014 to 5.1 (95%CI: 4.9-5.2) per 100 person-years in 2016. Results of the slide positivity of the sentinel hospital also confirm these results. Resurgence of malaria was mainly due to Plasmodium vivax during program II and III. This study indicates that strategy adopted in program I (2008-2011) should be more appropriate for the KR2. Quality-assured treatment of all confirmed, clinical and suspected malaria cases may be helpful for the reduction of malaria burden.
尽管基于药物的治疗是疟疾控制和消除的主要干预措施，但针对靶向治疗的最佳使用方法仍不清楚。 2008 年至 2016 年，缅甸克钦邦第二特别行政区（KR2）开展了三项针对治疗的靶向计划。计划 I（2008-2011 年）治疗所有确诊、临床和疑似病例；计划 II（2012-2013 年）治疗确诊和临床病例；计划 III（2014-2016 年）仅针对确诊病例进行治疗。本研究旨在根据年度寄生虫发病率（API）、幻灯片阳性率（SPR）及其相对值，分别评估这三个计划对疟疾负担的影响。API 是根据原始收集的数据计算得出的，每年的发病率比（IRR）是通过在 KR2 中每个计划阶段将第一年的 API 用作参考来计算的。同样的方法也应用于计算哨点医院的 SPR 和风险比（RR）。在计划 I（2008-2011 年）期间，疟疾负担减少了 61%（95%CI：58%-74%），实际 API 从 2008 年的每 100 人年 9.8（95%CI：9.6-10.1）降至 2011 年的每 100 人年 3.8（3.6-4.1）。在计划 II（2012-2013 年）期间，疟疾负担增加了 33%（95%CI：22%-46%），实际 API 从 2012 年的每 100 人年 2.1（95%CI：2.0-2.3）增加到 2013 年的每 100 人年 2.8（95%CI：2.7-2.9）。在计划 III（2014-2016 年）期间，疟疾负担进一步增加了 60%（95%CI：51%-69%），实际 API 从 2014 年的每 100 人年 3.2（95%CI：3.0-3.3）增加到 2016 年的每 100 人年 5.1（95%CI：4.9-5.2）。哨点医院的幻灯片阳性率结果也证实了这些结果。疟疾的再次出现主要是由于计划 II 和 III 期间间日疟原虫。本研究表明，计划 I（2008-2011 年）采用的策略更适合 KR2。对所有确诊、临床和疑似疟疾病例进行有质量保证的治疗可能有助于减轻疟疾负担。
