Indian Institute of Public Health, Bhubaneswar, Odisha, India.
Health and Family Welfare Department, Government of Odisha, Bhubaneswar, Odisha, India.
PLoS One. 2019 Sep 6;14(9):e0221223. doi: 10.1371/journal.pone.0221223. eCollection 2019.
Malaria is a public health emergency in India and Odisha. The national malaria elimination programme aims to expedite early identification, treatment and follow-up of malaria cases in hot-spots through a robust health system, besides focusing on efficient vector control. This study, a result of mass screening conducted in a hot-spot in Odisha, aimed to assess prevalence, identify and estimate the risks and develop a management tool for malaria elimination.
Through a cross-sectional study and using WHO recommended Rapid Diagnostic Test (RDT), 13221 individuals were screened. Information about age, gender, education and health practices were collected along with blood sample (5 μl) for malaria testing. Altitude, forestation, availability of a village health worker and distance from secondary health center were captured using panel technique. A multi-level poisson regression model was used to analyze association between risk factors and prevalence of malaria, and to estimate risk scores.
The prevalence of malaria was 5.8% and afebrile malaria accounted for 79 percent of all confirmed cases. Higher proportion of Pv infections were afebrile (81%). We found the prevalence to be 1.38 (1.1664-1.6457) times higher in villages where the Accredited Social Health Activist (ASHA) didn't stay; the risk increased by 1.38 (1.0428-1.8272) and 1.92 (1.4428-2.5764) times in mid- and high-altitude tertiles. With regard to forest coverage, villages falling under mid- and highest-tertiles were 2.01 times (1.6194-2.5129) and 2.03 times (1.5477-2.6809), respectively, more likely affected by malaria. Similarly, villages of mid tertile and lowest tertile of education had 1.73 times (1.3392-2.2586) and 2.50 times (2.009-3.1244) higher prevalence of malaria.
Presence of ASHA worker in villages, altitude, forestation, and education emerged as principal predictors of malaria infection in the study area. An easy-to-use risk-scoring system for ranking villages based on these risk factors could facilitate resource prioritization for malaria elimination.
疟疾是印度和奥里萨邦的公共卫生紧急事件。国家消除疟疾计划旨在通过强大的卫生系统，加速对热点地区疟疾病例的早期发现、治疗和随访，同时注重有效的病媒控制。本研究是在奥里萨邦一个热点地区进行大规模筛查的结果，旨在评估疟疾的流行率、确定和估计风险，并开发一种用于消除疟疾的管理工具。
通过横断面研究和使用世界卫生组织推荐的快速诊断测试（RDT），对 13221 人进行了筛查。收集了年龄、性别、教育和卫生习惯等信息，并采集了 5 μl 的血样进行疟疾检测。使用面板技术记录了海拔、森林覆盖率、乡村卫生工作者的可用性以及距离二级保健中心的距离。采用多水平泊松回归模型分析了疟疾流行率与风险因素之间的关联，并估计了风险评分。
疟疾的流行率为 5.8%，无热疟占所有确诊病例的 79%。更高比例的 Pf 感染是无热的（81%）。我们发现，在没有认证社会卫生活动家（ASHA）居住的村庄，疟疾病例的流行率高出 1.38 倍（1.1664-1.6457）；在中海拔和高海拔的 tertiles 中，风险分别增加了 1.38 倍（1.0428-1.8272）和 1.92 倍（1.4428-2.5764）。关于森林覆盖率，中 tertile 和高 tertile 下的村庄受疟疾影响的可能性分别高出 2.01 倍（1.6194-2.5129）和 2.03 倍（1.5477-2.6809）。同样，中 tertile 和最低 tertile 的教育程度的村庄的疟疾流行率分别高出 1.73 倍（1.3392-2.2586）和 2.50 倍（2.009-3.1244）。
在研究区域中，ASHA 工人在村庄中的存在、海拔、森林覆盖和教育程度是疟疾感染的主要预测因素。一种基于这些风险因素对村庄进行排名的易于使用的风险评分系统，可以为疟疾消除工作提供资源优先排序。
