Department of Population Health and Disease Prevention, University of California, Irvine, United States.
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand.
Elife. 2019 Apr 16;8:e41023. doi: 10.7554/eLife.41023.
The global malaria burden has decreased over the last decade and many nations are attempting elimination. Asymptomatic malaria infections are not normally diagnosed or treated, posing a major hurdle for elimination efforts. One solution to this problem is mass drug administration (MDA), with success depending on adequate population participation. Here, we present a detailed spatial and temporal analysis of malaria episodes and asymptomatic infections in four villages undergoing MDA in Myanmar. In this study, individuals from neighborhoods with low MDA adherence had 2.85 times the odds of having a malaria episode post-MDA in comparison to those from high adherence neighborhoods, regardless of individual participation, suggesting a herd effect. High mosquito biting rates, living in a house with someone else with malaria, or having an asymptomatic malaria infection were also predictors of clinical episodes. Spatial clustering of non-adherence to MDA, even in villages with high overall participation, may frustrate elimination efforts.
在过去的十年中，全球疟疾负担有所减轻，许多国家都在努力消除疟疾。无症状的疟疾感染通常无法被诊断或治疗，这对消除疟疾的努力构成了重大障碍。解决这一问题的一种方法是大规模药物治疗（MDA），其成功与否取决于足够的人口参与。在这里，我们对缅甸四个正在接受 MDA 的村庄的疟疾发作和无症状感染进行了详细的时空分析。在这项研究中，与来自高参与度社区的人相比，MDA 参与度低的社区的个体在 MDA 后发生疟疾发作的几率高出 2.85 倍，而不管个人参与情况如何，这表明存在群体效应。高蚊虫叮咬率、与患有疟疾的人同住一个房间或患有无症状的疟疾感染也是临床发作的预测因素。即使在总体参与度较高的村庄，MDA 参与度的空间聚类也可能会影响消除疟疾的努力。
