Department of Anthropology, University of Amsterdam, Building B-REC B 8.01, Nieuwe Achtergracht 166, 1018, WV, Amsterdam, The Netherlands.
The Carter Center, 453 Freedom Parkway, Atlanta, GA, 30307, USA.
Infect Dis Poverty. 2019 May 27;8(1):39. doi: 10.1186/s40249-019-0547-3.
The island of Hispaniola, shared by Haiti and the Dominican Republic (DR), is the only remaining malaria-endemic island in the Caribbean and accounts for 95% of the lymphatic filariasis (LF) burden in the Americas. Both countries aim to eliminate the diseases by 2020. Migration from Haiti, where both diseases are more prevalent, may promote transmission in the DR. Historically, Haitian migrant labourers live in rural Dominican agricultural 'company towns' called bateyes, many of which received mass drug administration (MDA) for LF elimination. This study sought to determine the prevalence of malaria and LF in bateyes of the DR and to describe related risk factors for disease.
From March to April 2016, a cross-sectional, cluster survey was conducted across Dominican bateyes stratified into three regions: southwest, north and east. A household questionnaire (n = 776), captured demographics, ethnic origin, mobility patterns, malaria intervention coverage, and knowledge, and recent fever and treatment-seeking. Two individuals per household (n = 1418) were tested for malaria parasites by microscopy and rapid diagnostic test (RDT) and LF antigen by filariasis test strip (FTS). Population-level estimates and confidence intervals (CI) were computed adjusting for the survey design. Two-sided t-tests compared differences in knowledge scores.
No (0%) blood sample was Plasmodium-positive by microscopy or RDT. Six individuals were FTS-positive (0.5%; 95% CI: 0.2-1.5), but none (0%) of these were microfilariae-positive. Most batey residents were born in the DR (57.8%), documented (85.0%), and permanent residents (85.1%). Very few respondents (9.4%) reported travel to Haiti in the past year. Overall, half (53.8%) of respondents owned a bed net, and 82.3% of net owners reported using it the previous night. Indoor residual spraying (IRS) differed by region (range: 4.7%-61.2%). Most of those with recent fever sought care (56.0%), yet only 30.5% of those seeking care were tested for malaria. Compared to Dominican-born populations, Haitian-born respondents more frequently reported recent fever, did not seek care for the fever, had not heard of malaria, and could not name symptoms or prevention methods.
Malaria and LF transmission appear absent or extremely low in Dominican bateyes, which are a mixture of Haitian and Dominican residents. Travel to Haiti is rare, meaning risk of malaria and LF importation is low. Addressing identified gaps in intervention coverage, malaria knowledge, treatment seeking and service delivery will improve the quality of surveillance for these diseases, particularly among marginalized populations and promote island-wide elimination.
海地和多米尼加共和国（DR）共享的伊斯帕尼奥拉岛是加勒比地区唯一仍存在疟疾的岛屿，占美洲淋巴丝虫病（LF）负担的 95%。两国都计划在 2020 年之前消灭这两种疾病。来自海地的移民，这两种疾病更为普遍，可能会促进 DR 中的传播。历史上，海地移民劳工居住在多米尼加农村农业“公司城镇”称为 bateyes，其中许多城镇都接受了大规模药物管理（MDA）以消除 LF。本研究旨在确定 DR 中 bateyes 的疟疾和 LF 的流行情况，并描述与疾病相关的危险因素。
2016 年 3 月至 4 月，在多米尼加共和国的 bateyes 中进行了一项横断面，聚类调查，这些 bateyes 分为三个区域：西南，北部和东部。家庭问卷（n = 776），记录了人口统计学，种族起源，流动模式，疟疾干预措施的覆盖率以及知识，近期发热和寻求治疗情况。每个家庭有两个人（n = 1418）进行了显微镜检查和快速诊断检测（RDT）检查疟疾寄生虫，并用丝虫病检测带（FTS）检查 LF 抗原。对调查设计进行了调整，计算了人口水平的估计值和置信区间（CI）。双侧 t 检验比较了知识得分的差异。
没有（0%）血液样本通过显微镜或 RDT 检测到疟原虫阳性。有 6 个人 FTS 阳性（0.5%； 95%CI：0.2-1.5），但没有人（0%）的微丝蚴阳性。大多数 batey 居民出生于多米尼加共和国（57.8%），有文件记录（85.0%），并为永久居民（85.1%）。很少有受访者（9.4%）报告在过去一年中前往海地。总体而言，有一半（53.8%）的受访者拥有蚊帐，并且有 82.3%的蚊帐拥有者报告说前一天晚上使用了它。室内滞留喷洒（IRS）因地区而异（范围：4.7%-61.2%）。大多数有近期发热的人都寻求了治疗（56.0%），但只有 30.5%的寻求治疗的人接受了疟疾检查。与出生于多米尼加共和国的人群相比，出生于海地的受访者更频繁地报告有近期发热，没有因发热而寻求治疗，没有听说过疟疾，也无法说出症状或预防方法。
多米尼加共和国的 bateyes 中疟疾和 LF 的传播似乎不存在或极低，这些 bateyes 是海地和多米尼加居民的混合体。前往海地的旅行很少，这意味着疟疾和 LF 输入的风险很低。解决干预措施覆盖率，疟疾知识，治疗寻求和服务提供方面的差距，将改善这些疾病的监测质量，特别是在边缘化人群中，并促进全岛消除。
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