Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 42, Avenue Kumda-Yonre, Centre National de la Recherche Scientifique et Technologique, 11 BP 218 Ouaga CMS 11, Ouagadougou, Burkina Faso; Centre d'Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Route de Lennik, 808 B-1070, Bruxelles, Belgique.
Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute Research Center, Quebec City, QC G1V 4G5, Canada; Centre for Research on Planning and Development (CRAD), Laval University, Quebec, G1V 0A6, Canada.
Spat Spatiotemporal Epidemiol. 2020 Jun;33:100333. doi: 10.1016/j.sste.2020.100333. Epub 2020 Feb 15.
Fine-scale hotspots detection is crucial for optimum delivery of essential health-services for reducing severe malaria in pregnancy (MiP) and death cases in Burkina Faso. This study used hierarchical-Bayesian Spatio-temporal modeling to explore space-time patterns and pinpoint health-districts with an exceedance probability of severe MiP incidence and fatality rate. Study also assessed effect of health-district service delivery (readiness) on severe-MiP outcomes. Severe-MiP fatality rate declined considerably while its incidence rate remained unchanged between January-2013 and December-2018. Severe-MiP cases persisted throughout the year with peaks between August and November. These peaks increased 2.5-fold the fatality rate. Furthermore, severe-MiP fatality was higher in health-districts classified as low-readiness (IRR = 2.469, 95%CrI: 1.632-3.738). However, the fatality rate decreased significantly with proper coverage with three doses for intermittent-preventive-treatment with sulphadoxine-pyrimethamine. Severe-MiP burden was heterogeneous spatially and temporally. The study suggested that health-programs should increase health-districts readiness and optimize resource allocation in high burden areas and months.
精细尺度热点探测对于优化提供基本卫生服务以减少布基纳法索妊娠重症疟疾（MiP）和死亡病例至关重要。本研究使用分层贝叶斯时空建模来探索时空模式，并确定卫生区的重症 MiP 发病率和死亡率超过概率。研究还评估了卫生区服务提供（准备情况）对重症 MiP 结果的影响。在 2013 年 1 月至 2018 年 12 月期间，重症 MiP 的死亡率显著下降，而发病率保持不变。重症 MiP 病例全年持续存在，8 月至 11 月期间达到高峰。这些高峰期使死亡率增加了 2.5 倍。此外，被归类为低准备度的卫生区重症 MiP 的死亡率更高（IRR=2.469，95%CrI：1.632-3.738）。然而，随着使用磺胺多辛-乙胺嘧啶进行间歇性预防治疗的适当覆盖，死亡率显著下降。重症 MiP 的负担在空间和时间上存在异质性。研究表明，卫生规划应提高卫生区的准备程度，并在高负担地区和月份优化资源分配。
