Department of Public Health, Kagawa University Graduate School of Medicine, Miki-cho, 761-0793, Japan.
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
Malar J. 2021 Feb 27;20(1):117. doi: 10.1186/s12936-021-03647-9.
Malaria is one of the most prevalent and deadliest illnesses in sub-Saharan Africa. Despite recent gains made towards its control, many African countries still have endemic malaria transmission. This study aimed to assess malaria burden at household level in Kongo central province, Democratic Republic of Congo (DRC), and the impact of community participatory Water, Sanitation and Hygiene (WASH) Action programme.
Mixed method research was conducted in two semi-rural towns, Mbanza-Ngungu (a WASH action site) and Kasangulu (a WASH control site) in DRC between 1 January 2017 through March 2018, involving 625 households (3,712 household members). Baseline and post-intervention malaria surveys were conducted with the use of World Bank/WHO Malaria Indicator Questionnaire. An action research consisting of a six-month study was carried out which comprised two interventions: a community participatory WASH action programme aiming at eliminating mosquito breeding areas in the residential environment and a community anti-malaria education campaign. The latter was implemented at both study sites. In addition, baseline and post-intervention malaria rapid diagnostic test (RDT) was performed among the respondents. Furthermore, a six-month hospital-based epidemiological study was conducted at selected referral hospitals at each site from 1 January through June 2017 to determine malaria trend.
Long-lasting insecticide-treated net (LLIN) was the most commonly used preventive measure (55%); 24% of households did not use any measures. Baseline malaria survey showed that 96% of respondents (heads of households) reported at least one episode occurring in the previous six months; of them only 66.5% received malaria care at a health setting. In the Action Research, mean incident household malaria cases decreased significantly at WASH action site (2.3 ± 2.2 cases vs. 1.2 ± 0.7 cases, respectively; p < 0.05), whereas it remained unchanged at the Control site. Similar findings were observed with RDT results. Data collected from referral hospitals showed high malaria incidence rate, 67.4%. Low household income (ORa = 2.37; 95%CI: 1.05-3.12; p < 0.05), proximity to high risk area for malaria (ORa = 5.13; 95%CI: 2-29-8.07; p < 0.001), poor WASH (ORa = 4.10; 95%CI: 2.11-7.08; p < 0.001) were predictors of household malaria.
This research showed high prevalence of positive malaria RDT among the responders and high household malaria incidence, which were reduced by a 6-month WASH intervention. DRC government should scale up malaria control strategy by integrating efficient indoor and outdoor preventive measures and improve malaria care accessibility.
疟疾是撒哈拉以南非洲地区最流行和最致命的疾病之一。尽管在控制疟疾方面取得了一些进展，但许多非洲国家仍存在地方性疟疾传播。本研究旨在评估刚果民主共和国（DRC）中刚果中心省的家庭层面的疟疾负担，以及社区参与式水、环境卫生和个人卫生（WASH）行动方案的影响。
2017 年 1 月至 2018 年 3 月期间，在刚果民主共和国的两个半农村城镇 Mbanza-Ngungu（WASH 行动现场）和 Kasangulu（WASH 对照现场）进行了混合方法研究，涉及 625 户家庭（3712 户家庭）。使用世界银行/世界卫生组织疟疾指标问卷进行了基线和干预后疟疾调查。开展了一项为期六个月的行动研究，包括两项干预措施：旨在消除住宅环境中蚊子滋生地的社区参与式 WASH 行动方案和社区抗疟教育运动。后者在两个研究地点都实施了。此外，在应答者中进行了基线和干预后疟疾快速诊断检测（RDT）。此外，从 2017 年 1 月至 6 月，在每个地点的选定转诊医院进行了为期六个月的基于医院的流行病学研究，以确定疟疾趋势。
长效驱虫蚊帐（LLIN）是最常用的预防措施（55%）；24%的家庭没有采取任何措施。基线疟疾调查显示，96%的受访者（户主）报告在前六个月至少发生过一次；其中只有 66.5%在卫生机构接受了疟疾治疗。在行动研究中，WASH 行动现场的家庭疟疾病例发生率显著下降（2.3±2.2 例 vs. 1.2±0.7 例，p<0.05），而对照现场则没有变化。RDT 结果也有类似的发现。转诊医院收集的数据显示，疟疾发病率很高，为 67.4%。家庭收入低（ORa=2.37；95%CI：1.05-3.12；p<0.05）、靠近疟疾高危地区（ORa=5.13；95%CI：2-29-8.07；p<0.001）、卫生条件差（ORa=4.10；95%CI：2.11-7.08；p<0.001）是家庭疟疾的预测因素。
本研究显示，在应答者中进行的 RDT 阳性疟疾检测呈高发态势，且家庭疟疾发病率较高，但通过 6 个月的 WASH 干预得以降低。刚果民主共和国政府应通过整合有效的室内外预防措施和改善疟疾护理的可及性，扩大疟疾控制战略。
