Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia.
Medical Anthropology Unit, Institute of Tropical Medicine, Antwerp, Belgium.
Front Public Health. 2021 Feb 26;9:601152. doi: 10.3389/fpubh.2021.601152. eCollection 2021.
With significant declines in malaria, infections are increasingly clustered in households, or groups of households where malaria transmission is higher than in surrounding household/villages. To decrease transmission in such cases, reactive interventions target household members of clinical malaria cases, with the intervention unit (e.g., the "household/s") derived from an epidemiological and operational perspective. A lack of unanimity regarding the spatial range of the intervention unit calls for greater importance to be placed on social context in conceptualizing the appropriate unit. A novel malaria elimination strategy based on reactive treatment was recently evaluated by a cluster randomized trial in a low transmission setting in The Gambia. Transdisciplinary research was used to assess and improve the effectiveness of the intervention which consisted, among others, of reflecting on whether the household was the most adequate unit of analysis. The intervention was piloted on the smallest treatment unit possible and was further adapted following a better understanding of the social and epidemiological context. Intervention units defined according to (i) shared sleeping spaces and (ii) household membership, showed substantial limitations as it was not possible to define them clearly and they were extremely variable within the study setting. Incorporating local definitions and community preference in the trial design led to the appropriate intervention unit-the compound-defined as an enclosed space containing one or several households belonging to the same extended patrilineal family. Our study demonstrates the appropriateness of using transdisciplinary research for investigating alternative intervention units that are better tailored to reactive treatment approaches.
随着疟疾发病率的显著下降，感染病例越来越集中在家庭或家庭群体中，这些家庭或家庭群体中的疟疾传播率高于周围的家庭/村庄。在这种情况下，为了降低传播风险，反应性干预措施针对临床疟疾病例的家庭成员进行，干预单位（例如，“家庭/群体”）是从流行病学和操作角度得出的。干预单位的空间范围缺乏一致性，这就要求在概念化适当的单位时更加重视社会背景。最近，在冈比亚的一个低传播环境中，一项基于反应性治疗的新疟疾消除策略通过一项集群随机试验进行了评估。跨学科研究用于评估和提高干预措施的有效性，该干预措施除其他外，还包括反思家庭是否是最合适的分析单位。该干预措施在尽可能小的治疗单位进行了试点，并在更好地了解社会和流行病学背景后进行了进一步调整。根据（i）共享睡眠空间和（ii）家庭成员关系定义的干预单位存在很大的局限性，因为无法清楚地定义它们，并且在研究环境中它们变化非常大。在试验设计中纳入当地定义和社区偏好，导致了适当的干预单位——复合单位的确定，复合单位被定义为一个包含一个或多个属于同一扩展父系家族的家庭的封闭空间。我们的研究表明，使用跨学科研究来调查更好地适应反应性治疗方法的替代干预单位是合适的。
