Am J Trop Med Hyg. 2022 Jun 15;106(6):1791-1799. doi: 10.4269/ajtmh.21-1253.
Malaria incidence has declined in southern Zambia over recent decades, leading to efforts to achieve and sustain malaria elimination. Understanding the remaining disease burden is key to providing optimal health care. A longitudinal study conducted in a rural area of Choma District, Southern Province, Zambia, assessed the prevalence of and factors associated with symptoms of non-malarial illnesses and treatment-seeking behavior. We analyzed data collected monthly between October 2018 through September 2020 from 1,174 individuals from 189 households. No incident malaria cases were detected by rapid diagnostic tests among febrile participants. Mixed-effects logistic regression identified factors associated with cough, fever, diarrhea, and treatment-seeking. Incidence rates of cough (192 of 1,000 person-months), fever (87 of 1,000 person-months), and fever with cough (37 of 1,000 person-months) were highest among adults older than 65 years. Diarrhea incidence (37 of 1,000 person-months) was highest among children younger than 5 years. For every additional symptomatic household member, one's odds of experiencing symptoms increased: cough by 47% (95% CI, 40-55), fever by 31% (95% CI, 23-40), diarrhea by 31% (95% CI, 17-46), and fever with cough by 112% (95% CI, 90-137), consistent with household clustering of illnesses. However, between 35% and 75% of participants did not seek treatment for their symptoms. Treatment-seeking was most common for children 5 to 9 years old experiencing diarrhea (adjusted odds ratio, 3.61; 95% CI, 1.42-9.18). As malaria prevalence reduces, respiratory and diarrheal infections persist, particularly among young children but, notably, also among adults older than 65 years. Increasing awareness of the disease burden and treatment-seeking behavior are important for guiding resource re-allocation as malaria prevalence declines in this region.
在过去几十年里，赞比亚南部的疟疾发病率有所下降，这促使人们努力实现并维持疟疾消除。了解剩余的疾病负担是提供最佳医疗保健的关键。在赞比亚南部省乔马区的一个农村地区进行的一项纵向研究评估了非疟疾疾病的患病率和相关因素以及寻求治疗的行为。我们分析了 2018 年 10 月至 2020 年 9 月期间从 189 户家庭的 1174 名个体每月收集的数据。在发热参与者中，快速诊断测试未检测到疟疾病例。混合效应逻辑回归确定了与咳嗽、发热、腹泻和寻求治疗相关的因素。65 岁以上成年人的咳嗽（每 1000 人月 192 例）、发热（每 1000 人月 87 例）和发热伴咳嗽（每 1000 人月 37 例）发病率最高。5 岁以下儿童腹泻发病率（每 1000 人月 37 例）最高。每增加一个有症状的家庭成员，出现症状的几率就会增加：咳嗽增加 47%（95%CI，40-55），发热增加 31%（95%CI，23-40），腹泻增加 31%（95%CI，17-46），发热伴咳嗽增加 112%（95%CI，90-137），这与疾病在家户中聚集一致。然而，35%至 75%的参与者没有为他们的症状寻求治疗。最常见的治疗是 5 至 9 岁的儿童腹泻（调整后的优势比，3.61；95%CI，1.42-9.18）。随着疟疾发病率的降低，呼吸道和腹泻感染持续存在，特别是在幼儿中，但值得注意的是，65 岁以上的成年人也存在这些感染。随着疟疾在该地区的发病率下降，提高对疾病负担和治疗寻求行为的认识对于指导资源重新分配非常重要。
