Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Canton of Basel Stadt, Switzerland.
University of Basel, Basel, Canton of Basel Stadt, Switzerland.
PLoS One. 2019 Jul 25;14(7):e0219853. doi: 10.1371/journal.pone.0219853. eCollection 2019.
Considerable upscaling of malaria control efforts have taken place over the last 15 years in the Democratic Republic of Congo, the country with the second highest malaria case load after Nigeria. Malaria control interventions have been strengthened in line with the Millenium Development Goals. We analysed the effects of these interventions on malaria cases at health facility level, using a retrospective trend analysis of malaria cases between 2005 and 2014. Data were collected from outpatient and laboratory registers based on a sample of 175 health facilities that represents all eco-epidemiological malaria settings across the country.
We applied a time series analysis to assess trends of suspected and confirmed malaria cases, by health province and for different age groups. A linear panel regression model controlled for non-malaria outpatient cases, rain fall, nightlight intensity, health province and time fixed effects, was used to examine the relationship between the interventions and malaria case occurrences, as well as test positivity rates.
Overall, recorded suspected and confirmed malaria cases in the DRC have increased. The sharp increase in confirmed cases from 2010 coincides with the introduction of the new treatment policy and the resulting scale-up of diagnostic testing. Controlling for confounding factors, the introduction of rapid diagnostic tests (RDTs) was significantly associated with the number of tested and confirmed cases. The test positivity rate fluctuated around 40% without showing any trend.
The sharp increase in confirmed malaria cases from 2010 is unlikely to be due to a resurgence of malaria, but is clearly associated with improved diagnostic availability, mainly the introduction of RDTs. Before that, a great part of malaria cases were treated based on clinical suspicion. This finding points to a better detection of cases that potentially contributed to improved case management. Furthermore, the expansion of diagnostic testing along with the increase in confirmed cases implies that before 2010, cases were underreported, and that the accuracy of routine data to describe malaria incidence has improved.
在过去的 15 年中，刚果民主共和国（仅次于尼日利亚的疟疾发病第二高的国家）大幅加强了疟疾控制工作。疟疾控制干预措施是根据千年发展目标而加强的。我们分析了这些干预措施对医疗机构疟疾病例的影响，使用 2005 年至 2014 年疟疾病例的回顾性趋势分析。数据是从根据全国所有生态流行病学疟疾环境的样本收集的 175 个卫生设施的门诊和实验室登记册中收集的。
我们应用时间序列分析来评估疑似和确诊疟疾病例的趋势，按卫生省和不同年龄组进行分析。线性面板回归模型控制了非疟疾门诊病例、降雨量、夜间光照强度、卫生省和时间固定效应，用于检验干预措施与疟疾病例发生的关系，以及检验阳性率。
总体而言，刚果民主共和国记录的疑似和确诊疟疾病例有所增加。确诊病例从 2010 年开始急剧增加，这与新的治疗政策的出台和诊断检测的大规模推广相一致。控制混杂因素后，快速诊断检测（RDT）的引入与检测和确诊病例的数量显著相关。检测阳性率在 40%左右波动，没有显示出任何趋势。
2010 年确诊疟疾病例的急剧增加不太可能是疟疾复发的结果，而是与诊断工具可用性的提高，主要是 RDT 的引入明显相关。在此之前，很大一部分疟疾病例是根据临床怀疑进行治疗的。这一发现表明，病例的检测能力有所提高，这可能有助于改善病例管理。此外，诊断检测的扩大以及确诊病例的增加意味着在 2010 年之前，病例报告不足，常规数据描述疟疾发病率的准确性有所提高。
