School of Geography and Environmental Sciences, Ulster University, Coleraine, UK; School of Computing, Engineering and Intelligent Systems, Ulster University, Londonderry, United Kingdom; School of Nursing, Faculty of Life & Health Sciences, Jordanstown, Newtownabbey, United Kingdom.
Department of Biostatistics and Epidemiology, University of North Texas Health Science Centre, Fort Worth, TX, 76107, USA; Department of Geography, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
Environ Res. 2021 Jun;197:111017. doi: 10.1016/j.envres.2021.111017. Epub 2021 Mar 22.
In the last decade, many malaria-endemic countries, like Zambia, have achieved significant reductions in malaria incidence among children <5 years old but face ongoing challenges in achieving similar progress against malaria in older age groups. In parts of Zambia, changing climatic and environmental factors are among those suspectedly behind high malaria incidence. Changes and variations in these factors potentially interfere with intervention program effectiveness and alter the distribution and incidence patterns of malaria differentially between young children and the rest of the population. We used parametric and non-parametric statistics to model the effects of climatic and socio-demographic variables on age-specific malaria incidence vis-à-vis control interventions. Linear regressions, mixed models, and Mann-Kendall tests were implemented to explore trends, changes in trends, and regress malaria incidence against environmental and intervention variables. Our study shows that while climate parameters affect the whole population, their impacts are felt most by people aged ≥5 years. Climate variables influenced malaria substantially more than mosquito nets and indoor residual spraying interventions. We establish that climate parameters negatively impact malaria control efforts by exacerbating the transmission conditions via more conducive temperature and rainfall environments, which are augmented by cultural and socioeconomic exposure mechanisms. We argue that an intensified communications and education intervention strategy for behavioural change specifically targeted at ≥5 aged population where incidence rates are increasing, is urgently required and call for further malaria stratification among the ≥5 age groups in the routine collection, analysis and reporting of malaria mortality and incidence data.
在过去的十年中，许多疟疾流行国家（如赞比亚）在 5 岁以下儿童疟疾发病率方面取得了显著降低，但在老年人群中实现类似的疟疾控制进展仍面临挑战。在赞比亚的一些地区，变化的气候和环境因素被认为是疟疾高发的原因之一。这些因素的变化和差异可能会干扰干预计划的效果，并改变疟疾在儿童和其他人群中的分布和发病率模式。我们使用参数和非参数统计方法来模拟气候和社会人口变量对特定年龄段疟疾发病率的影响，以及针对控制干预措施的影响。我们实施了线性回归、混合模型和曼肯德尔检验，以探讨趋势、趋势变化，并将疟疾发病率与环境和干预变量进行回归分析。我们的研究表明，虽然气候参数会影响整个人口，但对 5 岁及以上人群的影响最大。气候变量对疟疾的影响远远超过蚊帐和室内滞留喷洒干预措施。我们发现，气候参数通过更有利于疟疾传播的温度和降雨环境，以及文化和社会经济暴露机制，对疟疾控制工作产生负面影响，加剧了疟疾的传播条件。我们认为，迫切需要针对发病率上升的 5 岁及以上人群实施强化宣传和教育干预策略，以改变行为方式，并呼吁在疟疾死亡率和发病率数据的常规收集、分析和报告中，进一步对 5 岁以上人群进行疟疾分层。
