刚果民主共和国疟疾的个体、家庭和社区风险因素支持采取新的方案干预方法。
Individual, household and neighborhood risk factors for malaria in the Democratic Republic of the Congo support new approaches to programmatic intervention.
作者信息
Carrel Margaret, Kim Seungwon, Mwandagalirwa Melchior Kashamuka, Mvuama Nono, Bala Joseph A, Nkalani Marthe, Kihuma Georges, Atibu Joseph, Diallo Alpha Oumar, Goel Varun, Thwai Kyaw L, Juliano Jonathan J, Emch Michael, Tshefu Antoinette, Parr Jonathan B
机构信息
Department of Geographical & Sustainability Sciences, 305 Jessup Hall, University of Iowa, Iowa City, IA, 52245, USA.
Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA; Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, USA.
出版信息
Health Place. 2021 Jul;70:102581. doi: 10.1016/j.healthplace.2021.102581. Epub 2021 May 18.
BACKGROUND
The Democratic Republic of the Congo (DRC) remains one of the countries most impacted by malaria despite decades of control efforts, including multiple mass insecticide treated net (ITN) distribution campaigns. The multi-scalar and complex nature of malaria necessitates an understanding of malaria risk factors over time and at multiple levels (e.g., individual, household, community). Surveillance of households in both rural and urban settings over time, coupled with detailed behavioral and geographic data, enables the detection of seasonal trends in malaria prevalence and malaria-associated behaviors as well as the assessment of how the local environments within and surrounding an individual's household impact malaria outcomes.
METHODS
Participants from seven sites in Kinshasa Province, DRC were followed for over two years. Demographic, behavioral, and spatial information was gathered from enrolled households. Malaria was assessed using both rapid diagnostic tests (RDT) and polymerase chain reaction (PCR) and seasonal trends were assessed. Hierarchical regression modeling tested associations between behavioral and environmental factors and positive RDT and PCR outcomes at individual, household and neighborhood scales.
RESULTS
Among 1591 enrolled participants, malaria prevalence did not consistently vary seasonally across the sites but did vary by age and ITN usage. Malaria was highest and ITN usage lowest in children ages 6-15 years across study visits and seasons. Having another member of the household test positive for malaria significantly increased the risk of an individual having malaria [RDT: OR = 4.158 (2.86-6.05); PCR: OR = 3.37 (2.41-4.71)], as did higher malaria prevalence in the 250 m neighborhood around the household [RDT: OR = 2.711 (1.42-5.17); PCR: OR = 4.056 (2.3-7.16)]. Presence of water within close proximity to the household was also associated with malaria outcomes.
CONCLUSIONS
Taken together, these findings suggest that targeting non-traditional age groups, children >5 years old and teenagers, and deploying household- and neighborhood-focused interventions may be effective strategies for improving malaria outcomes in high-burden countries like the DRC.
背景
尽管经过数十年的防控努力，包括多次大规模分发经杀虫剂处理的蚊帐（ITN），刚果民主共和国（DRC）仍然是受疟疾影响最严重的国家之一。疟疾具有多尺度和复杂性，这就需要了解不同时间和多个层面（如个人、家庭、社区）的疟疾风险因素。对农村和城市地区的家庭进行长期监测，再结合详细的行为和地理数据，有助于发现疟疾流行率和与疟疾相关行为的季节性趋势，以及评估个人家庭内部和周围的当地环境如何影响疟疾的发病情况。
方法
对来自刚果民主共和国金沙萨省七个地点的参与者进行了两年多的跟踪研究。收集了登记家庭的人口统计学、行为和空间信息。使用快速诊断测试（RDT）和聚合酶链反应（PCR）评估疟疾情况，并评估季节性趋势。分层回归模型测试了行为和环境因素与个人、家庭和社区层面RDT和PCR阳性结果之间的关联。
结果
在1591名登记参与者中，各地点的疟疾流行率并非始终呈现季节性变化，但因年龄和ITN使用情况而有所不同。在整个研究访问和季节中，6至15岁儿童的疟疾发病率最高，ITN使用率最低。家庭中有另一名成员的疟疾检测呈阳性，会显著增加个人感染疟疾的风险[RDT：比值比（OR）=4.158（2.86 - 6.05）；PCR：OR = 3.37（2.41 - 4.71）]，家庭周围250米范围内较高的疟疾流行率也会增加这种风险[RDT：OR = 2.711（1.42 - 5.17）；PCR：OR = 4.056（2.3 - 7.16）]。家庭附近有水也与疟疾发病情况有关。
结论
综合来看，这些研究结果表明，针对非传统年龄组（5岁以上儿童和青少年），并开展以家庭和社区为重点的干预措施，可能是改善刚果民主共和国等高负担国家疟疾防治效果的有效策略。
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