Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
BMJ Glob Health. 2020 Jun;5(6). doi: 10.1136/bmjgh-2020-002316.
Adults are frequently infected with malaria and may serve as a reservoir for further transmission, yet we know relatively little about risk factors for adult infections. In this study, we assessed malaria risk factors among adults using samples from the nationally representative, cross-sectional 2013-2014 Demographic and Health Survey (DHS) conducted in the Democratic Republic of the Congo (DRC). We further explored differences in risk factors by urbanicity.
infection was determined by PCR. Covariates were drawn from the DHS to model individual, community and environmental-level risk factors for infection. Additionally, we used deep sequencing data to estimate the community-level proportions of drug-resistant infections and included these estimates as potential risk factors. All identified factors were assessed for differences in associations by urbanicity.
A total of 16 126 adults were included. Overall prevalence of malaria was 30.3% (SE=1.1) by PCR; province-level prevalence ranged from 6.7% to 58.3%. Only 17% of individuals lived in households with at least one bed-net for every two people, as recommended by the WHO. Protective factors included increasing within-household bed-net coverage (Prevalence Ratio=0.85, 95% CI=0.76-0.95) and modern housing (PR=0.58, 95% CI=0.49-0.69). Community-level protective factors included increased median wealth (PR=0.87, 95% CI=0.83-0.92). Education, wealth, and modern housing showed protective associations in cities but not in rural areas.
The DRC continues to suffer from a high burden of malaria; interventions that target high-risk groups and sustained investment in malaria control are sorely needed. Areas of high prevalence should be prioritised for interventions to target the largest reservoirs for further transmission.
成年人经常感染疟疾，可能成为进一步传播的传染源，但我们对成人感染的危险因素知之甚少。在这项研究中，我们使用来自刚果民主共和国（DRC）全国代表性的横断面 2013-2014 年人口与健康调查（DHS）的样本，评估了成年人的疟疾危险因素。我们进一步探索了城市和农村地区之间的风险因素差异。
通过 PCR 确定感染。从 DHS 中提取协变量，以对个体、社区和环境层面的感染危险因素进行建模。此外，我们使用深度测序数据来估计社区层面耐药感染的比例，并将这些估计作为潜在的危险因素。所有确定的因素都根据城市和农村地区的差异进行了关联评估。
共纳入 16126 名成年人。总体疟疾 PCR 阳性率为 30.3%（SE=1.1）；省级水平的阳性率范围为 6.7%至 58.3%。只有 17%的人居住在每个两人至少有一个蚊帐的家庭中，这是世卫组织推荐的。保护因素包括增加家庭内蚊帐覆盖率（患病率比=0.85，95%置信区间=0.76-0.95）和现代住房（PR=0.58，95%置信区间=0.49-0.69）。社区层面的保护因素包括增加中位数财富（PR=0.87，95%置信区间=0.83-0.92）。教育、财富和现代住房在城市中表现出保护作用，但在农村地区则不然。
刚果民主共和国继续遭受疟疾的高负担；迫切需要针对高危人群的干预措施和对疟疾控制的持续投资。应优先考虑高患病率地区，以针对进一步传播的最大传染源进行干预。
