ANDI Centre of Excellence for Malaria Diagnosis, College of Medicine, University of Lagos, Lagos, Nigeria
National Malaria Elimination Programme (NMEP), Federal Ministry of Health, Abuja, Nigeria.
BMJ Glob Health. 2021 Feb;6(2). doi: 10.1136/bmjgh-2020-004250.
Global progress in reducing malaria has stalled since 2015. Analysis of the situation is particularly needed in Nigeria, the country with by far the largest share of the burden, where approximately a quarter of all cases in the world are estimated to occur.
We analysed data from three nationwide surveys (Malaria Indicator Surveys in 2010 and 2015 and a National Demographic and Health Survey in 2018), with malaria parasite prevalence in children under 5 years of age determined by sampling from all 36 states of Nigeria, and blood slide microscopy performed in the same accredited laboratory for all samples. Changes over time were evaluated by calculating prevalence ratio (PR) values with 95% CIs for each state, together with Mantel-Haenszel-adjusted PRs (PR) for each of the six major geopolitical zones of the country.
Between 2010 and 2018, there were significant reductions in parasite prevalence in 25 states, but not in the remaining 11 states. Prevalence decreased most in southern zones of the country (South West PR=0.53; South East PR=0.59; South South PR=0.51) and the North Central zone (PR=0.36). Changes in the north were less marked, but were significant and indicated overall reductions by more than 20% (North-West PR=0.74; North East PR=0.70). Changes in the south occurred mostly between 2010 and 2015, whereas those in the north were more gradual and most continued after 2015. Recent changes were not correlated with survey-reported variation in use of preventive measures.
Reductions in malaria infection in children under 5 have occurred in most individual states in Nigeria since 2010, but substantial geographical variation in the timing and extent indicate challenges to be overcome to enable global malaria reduction.
自 2015 年以来，全球在减少疟疾方面的进展已经停滞。在尼日利亚这个全球疟疾负担最大的国家，尤其需要对这种情况进行分析，据估计，全球约四分之一的疟疾病例发生在该国。
我们分析了来自三次全国性调查的数据（2010 年、2015 年的疟疾指标调查和 2018 年的全国人口与健康调查），从尼日利亚的 36 个州中抽取所有儿童进行抽样检测，确定 5 岁以下儿童的疟原虫感染率，所有样本均在同一经认可的实验室进行血片显微镜检查。通过计算每个州的患病率比值（PR）值及其 95%置信区间，以及该国六个主要地缘政治区的每个区的曼特尔-哈塞尔调整后的 PR（PR）值，评估随时间的变化。
在 2010 年至 2018 年间，25 个州的寄生虫患病率显著下降，但仍有 11 个州没有下降。该国南部地区（西南部 PR=0.53；东南部 PR=0.59；南部南部 PR=0.51）和中部地区（PR=0.36）的降幅最大。北部地区的变化不太明显，但也很显著，表明总体降幅超过 20%（西北部 PR=0.74；东北部 PR=0.70）。南部地区的变化主要发生在 2010 年至 2015 年之间，而北部地区的变化则较为渐进，且大部分发生在 2015 年之后。最近的变化与调查中报告的预防措施使用情况的变化无关。
自 2010 年以来，尼日利亚大多数州的 5 岁以下儿童的疟疾感染率有所下降，但在时间和程度上存在显著的地域差异，这表明在实现全球疟疾减少目标方面仍存在挑战。
