1The DHS Program, ICF, Rockville, Maryland.
2The DHS Program, Vysnova Partners, Landover, Maryland.
Am J Trop Med Hyg. 2021 Feb 1;104(4):1375-1382. doi: 10.4269/ajtmh.20-1351.
To date, the only robust estimates of severe malaria cases include children who present to the formal healthcare system. It is a challenge to use these data because of varying age ranges of reporting, different diagnosis techniques, surveillance methods, and healthcare utilization. This analysis examined data from 37 Demographic and Health Surveys and Malaria Indicator Surveys across 19 countries in sub-Saharan Africa collected between 2011 and 2018. The outcome of interest is a proxy indicator for severe malaria, defined as a proportion of children aged 6-59 months with at least one self-reported symptom of severe illness including loss of consciousness, rapid breathing, seizures, or severe anemia (hemoglobin < 5 g/dL) among those who were positive for malaria. The study includes a weighted descriptive, country-level analysis and a multilevel mixed-effects logistic regression model to assess the determinants of severe malaria. Among children positive for malaria across all surveys, 4.5% (95% CI: 4.1-4.8) had at least one sign or symptom of severe malaria, which was significantly associated with age, residence, wealth, and year of survey fieldwork at a P-value less than 0.05. This analysis presents a novel and an alternative approach of estimating the fraction of severe malaria cases among malaria-positive children younger than 5 years in malaria-endemic countries. Estimating severe malaria cases through population-based surveys allows countries to estimate severe malaria across time and to compare with other countries. Having a population-level estimate of severe malaria cases helps further our understanding of the burden and epidemiology of severe malaria.
迄今为止，对严重疟疾病例的唯一可靠估计包括出现在正规医疗体系中的儿童。由于报告的年龄范围不同、不同的诊断技术、监测方法和医疗保健利用情况，使用这些数据具有一定挑战性。本分析使用了来自撒哈拉以南非洲 19 个国家的 37 次人口与健康调查和疟疾指标调查的数据，这些数据是在 2011 年至 2018 年间收集的。感兴趣的结果是严重疟疾的替代指标，定义为在那些疟疾检测阳性的儿童中，至少有一种严重疾病的自我报告症状（包括失去意识、呼吸急促、癫痫发作或严重贫血（血红蛋白<5g/dL））的比例。该研究包括一个加权描述性的国家层面分析和一个多水平混合效应逻辑回归模型，以评估严重疟疾的决定因素。在所有调查中检测出疟疾阳性的儿童中，有 4.5%（95%CI：4.1-4.8）至少有一种严重疟疾的体征或症状，这与年龄、居住地、财富和调查现场年份在 P 值小于 0.05 时具有显著相关性。本分析提出了一种新颖的替代方法，用于估计疟疾流行国家 5 岁以下疟疾阳性儿童中严重疟疾病例的比例。通过基于人群的调查估计严重疟疾病例，使各国能够在不同时间估计严重疟疾，并与其他国家进行比较。对严重疟疾病例进行人群水平的估计有助于我们进一步了解严重疟疾的负担和流行病学。
