多哥三个地区季节性疟疾化学预防的效果：2013 年至 2020 年的基于人群的纵向研究。
Effectiveness of seasonal malaria chemoprevention in three regions of Togo: a population-based longitudinal study from 2013 to 2020.
机构信息
Université de Lyon, Lyon, France.
Université Lyon 1, 69100, Villeurbanne, France.
出版信息
Malar J. 2022 Dec 31;21(1):400. doi: 10.1186/s12936-022-04434-w.
BACKGROUND
In 2012, the World Health Organization (WHO) recommended seasonal malaria chemoprevention (SMC) in areas of high seasonal transmission. Though implemented since 2013, the effectiveness of SMC in Togo was never evaluated.
METHODS
This study concerned routine data from 2013 to 2020 mass SMC campaigns for children under five in all health facilities of three Regions of Togo. Treatment coverage, reasons for non-treatment, and SMC-attributable adverse reactions were analysed per year and treatment round. Random effect logistic models estimated SMC effectiveness per health district, year, and treatment round.
RESULTS
The overall coverage was 98% (7,971,877 doses for 8,129,668 children). Contraindication was the main reason for non-administration. Over the study period, confirmed malaria cases decreased from 11,269 (1st round of 2016) to 1395 (4th round of 2020). Only 2,398 adverse reactions were reported (prevalence: 3/10,000), but no severe Lyell syndrome or Stevens-Johnson-type skin reaction. Compared to 2016, malaria prevalence decrease was estimated at 22.6% in 2017 (p < 0.001) and 75% in 2020 (p < 0.001). SMC effectiveness ranged from 76.6% (2nd round) to 96.2% (4th round) comparison with the 1st round.
CONCLUSIONS
SMC reduced significantly malaria cases among children under five. The results reassure all actors and call for effort intensification to reach the WHO goals for 2030.
背景
2012 年，世界卫生组织（WHO）建议在高季节性传播地区开展季节性疟疾化学预防（SMC）。尽管自 2013 年以来一直在实施，但从未对多哥的 SMC 效果进行评估。
方法
本研究涉及 2013 年至 2020 年期间在多哥三个地区所有卫生机构中为五岁以下儿童开展的大规模 SMC 运动的常规数据。每年和每个治疗轮次分析治疗覆盖率、未治疗的原因以及 SMC 相关不良反应。随机效应逻辑模型按卫生区、年份和治疗轮次估计 SMC 效果。
结果
总体覆盖率为 98%（7971877 剂用于 8129668 名儿童）。禁忌症是未给药的主要原因。在研究期间，确诊疟疾病例从 2016 年第一轮的 11269 例减少到 2020 年第四轮的 1395 例。仅报告了 2398 例不良反应（发生率：每 10000 人 3 例），但没有严重的莱尔氏综合征或史蒂文斯-约翰逊型皮肤反应。与 2016 年相比，2017 年疟疾流行率下降估计为 22.6%（p<0.001），2020 年下降 75%（p<0.001）。与第一轮相比，SMC 效果范围为 76.6%（第二轮）至 96.2%（第四轮）。
结论
SMC 显著减少了五岁以下儿童的疟疾病例。结果使所有利益攸关方感到放心，并呼吁加紧努力，实现 2030 年世卫组织目标。
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