苏丹疟疾媒介控制活动的成本效益。

Cost effectiveness of malaria vector control activities in Sudan.

机构信息

Department of Environmental Health, Faculty of Public Health, Shendi University, Shendi, Sudan.

Vector Genetics and Control Laboratory, Department of Zoology, Faculty of Science, University of Khartoum, Khartoum, Sudan.

出版信息

Malar J. 2024 Mar 15;23(1):80. doi: 10.1186/s12936-024-04900-7.

DOI:10.1186/s12936-024-04900-7

PMID:38491492

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10943848/

Abstract

BACKGROUND

Malaria vector control activities in Sudan rely largely on Long-Lasting Insecticidal Nets (LLINs), Indoor Residual Spray (IRS) and Larval Source Management (LSM). The present study attempted to determine cost effectiveness of inputs and operations of vector control interventions applied in different environmental settings in central and eastern Sudan, as well as their impact.

METHODS

The inputs utilized and cost of each vector control activity, operational achievements and impact of the applied malaria vector control activities; IRS, LLINs and LSM were determined for eight sites in Al Gazira state (central Sudan) and Al Gadarif state (eastern Sudan). Operational costs were obtained from data of the National Malaria Control Program in 2017. Impact was measured using entomological indicators for Anopheles mosquitoes.

RESULTS

The total cost per person per year was $1.6, $0.85, and $0.32 for IRS, LLINs and LSM, respectively. Coverage of vector control operations was 97%, 95.2% and 25-50% in IRS, LLINs and LSM, respectively. Vectorial capacity of malaria vectors showed statistically significant variations (P < 0.034) and ranged 0.294-0.65 in areas implemented LSM in comparison to 0.097-0.248 in areas applied IRS and LLINs, respectively. Both indoor and outdoor biting Anopheles mosquitoes showed noticeable increase that reached 3-12 folds in areas implemented LSM in comparison to areas implemented IRS and LLINs. Annual malaria prevalence was 13.1-21.1% in areas implemented LSM in comparison to 3.20%, 4.77% in areas implemented IRS and LLINs, respectively.

CONCLUSION

IRS and LLINs are cost effective control measures due to adequate inputs and organized process. However, the unit cost of LSM intervention per outcome and subsequently the impact is hugely affected by the low coverage. The very weak support for implementation of LSM which includes inputs resulted in weakness of its process and consequently its impact. Implementation of LSM by local government in urban settings is challenged by many factors the most important are maintenance of adequate stable level of funding, un-adequate number of well trained health workers, unstable political and administrative conditions and weak infrastructure. These challenges are critical for proper implementation of LSM and control of malaria in urban settings in Sudan.

摘要

背景

苏丹的疟疾媒介控制活动主要依赖长效杀虫蚊帐（LLINs）、室内滞留喷洒（IRS）和幼虫源管理（LSM）。本研究试图确定在苏丹中部和东部不同环境中应用的媒介控制干预措施的投入和运营的成本效益及其影响。

方法

在 2017 年国家疟疾控制计划的数据基础上，确定了在加扎勒河州（苏丹中部）和加达里夫州（苏丹东部）的八个地点实施的 IRS、LLINs 和 LSM 的投入利用和每种媒介控制活动的成本、运营成果以及应用疟疾媒介控制活动的影响。采用按蚊的昆虫学指标来衡量影响。

结果

IRS、LLINs 和 LSM 每人每年的费用分别为 1.6 美元、0.85 美元和 0.32 美元。IRS、LLINs 和 LSM 的覆盖率分别为 97%、95.2%和 25-50%。疟疾媒介的媒介传播能力显示出统计学上的显著差异（P<0.034），在实施 LSM 的地区范围在 0.294-0.65，而在实施 IRS 和 LLINs 的地区范围分别在 0.097-0.248。室内和室外叮咬的按蚊蚊子数量明显增加，在实施 LSM 的地区增加了 3-12 倍，而在实施 IRS 和 LLINs 的地区增加了 3-12 倍。在实施 LSM 的地区，年疟疾患病率为 13.1-21.1%，而在实施 IRS 和 LLINs 的地区分别为 3.20%和 4.77%。

结论

IRS 和 LLINs 是具有成本效益的控制措施，因为它们有足够的投入和有组织的流程。然而，LSM 干预措施的单位成本效益和随后的影响受到低覆盖率的极大影响。由于缺乏对实施 LSM 的支持，包括投入，导致其过程薄弱，因此影响也很有限。地方政府在城市环境中实施 LSM 受到许多因素的挑战，最重要的是，维持充足、稳定的资金水平、缺乏足够数量的经过良好培训的卫生工作者、不稳定的政治和行政条件以及薄弱的基础设施。这些挑战对在苏丹城市环境中正确实施 LSM 和控制疟疾至关重要。