在巴西亚马逊地区疟疾风险区域使用和保留长效驱虫蚊帐（LLINs）：一项为期 5 年的干预随访。
Use and retention of long-lasting insecticidal nets (LLINs) in a malaria risk area in the Brazilian Amazon: a 5-year follow-up intervention.
机构信息
Laboratory of Parasitic Diseases, Institute Oswaldo Cruz/Fiocruz, Av Brasil 4365. Pavilhão Artur Neiva, Rio de Janeiro, RJ, CEP: 21040-900, Brazil.
Foundation of Health Surveillance of Amazonas, Av. Torquato Tapajós, 4.010, Colônia Santo Antônio, Manaus, AM, CEP 69.093-018, Brazil.
出版信息
Malar J. 2019 Mar 25;18(1):100. doi: 10.1186/s12936-019-2735-9.
BACKGROUND
Long-lasting insecticidal nets (LLINs) are one of the main vector control strategies recommended by the World Health Organization for the control and elimination of malaria. This study aimed to evaluate the use and retention of LLINs during the 5 years of implementing an integrated control strategy in a malaria-endemic area in the Brazilian Amazon.
METHODS
This intervention study was conducted in localities of the municipality of Barcelos, Amazonas, from 2008 to 2014. Four rural localities situated along the Padauiri River were the object of this study. Two localities (Bacabal-rio Aracá and the São Sebastião district) were used as controls. LLINs were distributed to all residents of the Padauiri River; assessments were made regarding their use and retention via a semistructured questionnaire, a household register, and direct observation during 5 years.
RESULTS
Overall, 208 individuals participated in the study. In the baseline pilot study (2008), 9.9% of the subjects in the intervention group had slept with mosquito nets the previous night compared with 37.8% of the subjects in the control group. In 2010, this percentage was 43.2% in the intervention group and 50.9% in the control group. Therefore, 1 year after the implementation of the strategy, although there was an increase in the use of mosquito nets in both groups, this increase was significantly higher in the intervention group. This increase in LLINs use did not persist after 5 years of intervention. The households' evaluation in 2014 showed that 80% of the houses in the intervention group owned at least one LLIN compared with 66% in the control group (p = 0.11); 76% of households in the intervention group owned sufficient LLINs for all family members compared with 50% in the control group (p = 0.007).
CONCLUSIONS
High ownership and retention of the LLINs was observed in the intervention group. At 1 year after the distribution of these LLINs, there was a significant increase in their use that was not maintained over the long term. Control strategies must be permanent; however, exploring new strategies is necessary to ensure that the knowledge acquired further modifies the attitudes and behaviours.
背景
长效驱虫蚊帐（LLINs）是世界卫生组织推荐的主要病媒控制策略之一，用于控制和消除疟疾。本研究旨在评估在巴西亚马逊的一个疟疾流行地区实施综合控制策略的 5 年内，长效驱虫蚊帐的使用和保留情况。
方法
这项干预研究于 2008 年至 2014 年在亚马逊州巴塞尔罗斯市的各个地方进行。Padauiri 河沿岸的四个农村地区是这项研究的对象。两个地区（Bacabal-rio Aracá 和圣塞巴斯蒂昂区）被用作对照。Padauiri 河的所有居民都分发了长效驱虫蚊帐；通过半结构化问卷、家庭登记册和 5 年内的直接观察评估其使用和保留情况。
结果
共有 208 人参加了这项研究。在基线试点研究（2008 年）中，干预组中前一晚有 9.9%的人睡在蚊帐里，而对照组中这一比例为 37.8%。2010 年，干预组的这一比例为 43.2%，对照组为 50.9%。因此，在策略实施 1 年后，尽管两组的蚊帐使用率都有所提高，但干预组的提高幅度明显更高。这种长效驱虫蚊帐使用的增加在干预 5 年后并未持续。2014 年的家庭评估显示，干预组 80%的房屋至少拥有一个长效驱虫蚊帐，而对照组为 66%（p=0.11）；干预组 76%的家庭拥有足够的长效驱虫蚊帐供所有家庭成员使用，而对照组为 50%（p=0.007）。
结论
干预组观察到长效驱虫蚊帐的高拥有率和保留率。在分发这些长效驱虫蚊帐后的 1 年内，其使用率显著增加，但长期来看并未得到维持。控制策略必须是永久性的；然而，有必要探索新的策略，以确保所获得的知识进一步改变态度和行为。
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