提高赞比亚南部消除疟疾中反应性病例检测的效率：一项横断面研究。
Improving the efficiency of reactive case detection for malaria elimination in southern Zambia: a cross-sectional study.
机构信息
MACS/WIHS Combined Cohort Study, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA.
出版信息
Malar J. 2020 May 7;19(1):175. doi: 10.1186/s12936-020-03245-1.
BACKGROUND
Reactive case detection (RCD) seeks to enhance malaria surveillance and control by identifying and treating parasitaemic individuals residing near index cases. In Zambia, this strategy starts with passive detection of symptomatic incident malaria cases at local health facilities or by community health workers, with subsequent home visits to screen-and-treat residents in the index case and neighbouring (secondary) households within a 140-m radius using rapid diagnostic tests (RDTs). However, a small circular radius may not be the most efficient strategy to identify parasitaemic individuals in low-endemic areas with hotspots of malaria transmission. To evaluate if RCD efficiency could be improved by increasing the probability of identifying parasitaemic residents, environmental risk factors and a larger screening radius (250 m) were assessed in a region of low malaria endemicity.
METHODS
Between January 12, 2015 and July 26, 2017, 4170 individuals residing in 158 index and 531 secondary households were enrolled and completed a baseline questionnaire in the catchment area of Macha Hospital in Choma District, Southern Province, Zambia. Plasmodium falciparum prevalence was measured using PfHRP2 RDTs and quantitative PCR (qPCR). A Quickbird™ high-resolution satellite image of the catchment area was used to create environmental risk factors in ArcGIS, and generalized estimating equations were used to evaluate associations between risk factors and secondary households with parasitaemic individuals.
RESULTS
The parasite prevalence in secondary (non-index case) households was 0.7% by RDT and 1.8% by qPCR. Overall, 8.5% (n = 45) of secondary households had at least one resident with parasitaemia by qPCR or RDT. The risk of a secondary household having a parasitaemic resident was significantly increased in proximity to higher order streams and marginally with increasing distance from index households. The adjusted OR for proximity to third- and fifth-order streams were 2.97 (95% CI 1.04-8.42) and 2.30 (95% CI 1.04-5.09), respectively, and that for distance to index households for each 50 m was 1.24 (95% CI 0.98-1.58).
CONCLUSION
Applying proximity to streams as a screening tool, 16% (n = 3) more malaria-positive secondary households were identified compared to using a 140-m circular screening radius. This analysis highlights the potential use of environmental risk factors as a screening strategy to increase RCD efficiency.
背景
反应性病例检测（RCD）旨在通过识别和治疗居住在索引病例附近的寄生虫血症个体来增强疟疾监测和控制。在赞比亚，该策略首先从当地卫生机构或社区卫生工作者被动检测有症状的偶发性疟疾病例开始，然后使用快速诊断检测（RDT）对索引病例和 140 米半径内的邻近（次要）家庭的居民进行家访筛查和治疗。然而，在疟疾传播热点的低流行地区，小的圆形半径可能不是识别寄生虫血症个体的最有效策略。为了评估通过增加识别寄生虫血症居民的可能性是否可以提高 RCD 的效率，在疟疾低度流行地区评估了环境风险因素和更大的筛查半径（250 米）。
方法
2015 年 1 月 12 日至 2017 年 7 月 26 日，在赞比亚南部省乔马区马查医院的集水区，共招募了 4170 名居住在 158 个索引和 531 个次要家庭的个体，并在基线问卷调查中完成了问卷调查。使用 PfHRP2 RDT 和定量 PCR（qPCR）测量恶性疟原虫的流行率。使用 Quickbird™高分辨率卫星图像在 ArcGIS 中创建环境风险因素，并使用广义估计方程评估风险因素与寄生虫血症个体的次要家庭之间的关联。
结果
通过 RDT 检测，次要（非索引病例）家庭的寄生虫患病率为 0.7%，通过 qPCR 检测为 1.8%。总体而言，qPCR 或 RDT 检测到 8.5%（n=45）的次要家庭有至少一名寄生虫血症居民。与距离索引家庭较近的家庭相比，靠近较高等级溪流的次要家庭寄生虫血症居民的风险显著增加，而与距离索引家庭的距离增加则略有增加。与第三级和第五级溪流的调整后的 OR 分别为 2.97（95%CI 1.04-8.42）和 2.30（95%CI 1.04-5.09），而距离每个 50 m 的索引家庭的距离则为 1.24（95%CI 0.98-1.58）。
结论
与使用 140 米圆形筛查半径相比，将溪流接近度用作筛查工具，可额外发现 16%（n=3）的疟疾阳性次要家庭。该分析强调了将环境风险因素用作筛查策略来提高 RCD 效率的潜力。
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