疟疾控制干预措施对灌溉地区疟疾感染和贫血的影响：苏丹基于人群的横断面研究。
Impact of malaria control interventions on malaria infection and anaemia in areas with irrigated schemes: a cross-sectional population-based study in Sudan.
机构信息
Health Information, Monitoring and Evaluation and Evidence Department, Federal Ministry of Health, Khartoum, Sudan.
Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.
出版信息
BMC Infect Dis. 2021 Dec 14;21(1):1248. doi: 10.1186/s12879-021-06929-4.
BACKGROUND
While the overall burden of malaria is still high, the global technical strategy for malaria advocates for two sets of interventions: vector control-based prevention and diagnosis and prompt effective treatment of malaria cases. This study aimed to assess the performance of malaria interventions on malaria infection and anaemia in irrigated areas in Sudan.
METHODS
Based on the Sudan 2016 national malaria indicator survey, data for two states (Gezira and Sennar), characterized by large-irrigated schemes, were analysed. Four community-level malaria interventions were used as contextual variables: utilization of malaria diagnosis, utilization of Artemisinin-based combination therapy (ACT), utilization of long-lasting insecticidal nets (LLINs) and coverage with indoor residual spraying (IRS). Association between these interventions and two outcomes: malaria infection and anaemia, was assessed separately. Malaria infection was assessed in all age groups while anaemia was assessed in children under 5 years. Multilevel multiple logistic regression analysis were conducted.
RESULTS
Among 4478 individuals involved in this study distributed over 47 clusters, the overall malaria infection rate was 3.0% and 56.5% of the children under 5 years (total = 322) were anaemic. Except for IRS coverage (69.6%), the average utilization of interventions was relatively low: 52.3% for utilization of diagnosis, 33.0% for utilization of ACTs and 18.6% for LLINs utilization. The multi-level multiple logistic regression model showed that only IRS coverage was associated with malaria infection (Odds ratio 0.83 per 10% coverage, 95%Confidence Interval (95%CI) 0.74-0.94, p = 0.003) indicating that a higher level of IRS coverage was associated with less malaria infection. Anaemia was not associated with any intervention (all p values larger than 0.1).
CONCLUSIONS
Malaria transmission in Gezira and Sennar areas is low. IRS, with insecticide to which vectors are susceptible, is an effective malaria control intervention in irrigated schemes. Community utilization of other interventions was not associated with malaria infection in this study. This may be due to the low utilization of these interventions. However, individual use of LLINs provide personal protection. This study failed to establish an association between anaemia and malaria control interventions in low transmission areas. The higher level of malaria infection in urban areas is a cause for concern.
背景
尽管疟疾的总体负担仍然很高，但全球疟疾技术战略提倡采取两组干预措施：以病媒控制为基础的预防和诊断以及及时有效地治疗疟疾病例。本研究旨在评估在苏丹灌溉地区疟疾干预措施对疟疾感染和贫血的效果。
方法
基于苏丹 2016 年国家疟疾指标调查，对两个以大型灌溉计划为特征的州（杰济拉和森纳尔）的数据进行了分析。将四项社区层面的疟疾干预措施作为背景变量：疟疾诊断的利用、青蒿素为基础的联合疗法（ACT）的利用、长效驱虫蚊帐（LLINs）的利用和室内滞留喷洒（IRS）的覆盖率。分别评估这些干预措施与两个结果之间的关系：疟疾感染和贫血。疟疾感染在所有年龄组中进行评估，而贫血在 5 岁以下儿童中进行评估。进行了多水平多逻辑回归分析。
结果
在参与本研究的 4478 个人中，分布在 47 个群组中，总体疟疾感染率为 3.0%，56.5%的 5 岁以下儿童（总数为 322 人）贫血。除 IRS 覆盖率（69.6%）外，干预措施的平均利用率相对较低：诊断利用率为 52.3%，ACT 利用率为 33.0%，LLINs 利用率为 18.6%。多水平多逻辑回归模型显示，只有 IRS 覆盖率与疟疾感染有关（每增加 10%覆盖率的优势比为 0.83，95%置信区间（95%CI）为 0.74-0.94，p=0.003），表明 IRS 覆盖率越高，疟疾感染越少。贫血与任何干预措施都无关（所有 p 值均大于 0.1）。
结论
在杰济拉和森纳尔地区，疟疾传播率较低。IRS 使用对病媒具有敏感性的杀虫剂，是灌溉计划中一种有效的疟疾控制干预措施。本研究中，社区对其他干预措施的利用与疟疾感染无关。这可能是由于这些干预措施的利用率较低。然而，个人使用 LLINs 可以提供个人保护。本研究未能在低传播地区建立贫血与疟疾控制干预措施之间的联系。城市地区较高的疟疾感染率令人担忧。
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