Department of Epidemiology, UAB Division of Hematology & Oncology, University of Alabama at Birmingham, 1808 7th Avenue S, Birmingham, AL, AL 35294, USA.
Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Malar J. 2024 Aug 19;23(1):249. doi: 10.1186/s12936-024-05075-x.
Nigeria has the highest malaria burden globally, and anti-malarials have been commonly used to treat malaria without parasitological confirmation. In 2012, Nigeria implemented rapid diagnostic tests (RDTs) to reduce the use of anti-malarials for those without malaria and to increase the use of artemisinin-based combination therapy (ACT) for malaria treatment. This study examined changes in anti-malarial receipt among children aged 6-59 months during a 12-year period of increasing RDT availability.
A cross-sectional analysis was conducted using the Nigeria Malaria Indicator Survey (NMIS) data from 2010 (before RDT implementation in 2012), 2015, and 2021. The analysis assessed trends in prevalence of malaria by survey RDT result, and fever and anti-malarial/ACT receipt in the 2 weeks prior to the survey. A multivariable logistic regression was used to account for the complex survey design and to examine factors associated with anti-malarial receipt, stratified by survey RDT result, a proxy for recent/current malaria infection.
In a nationally-representative, weighted sample of 22,802 children aged 6-59 months, fever prevalence remained stable over time, while confirmed malaria prevalence decreased from 51.2% in 2010 to 44.3% in 2015 and 38.5% in 2021 (trend test p < 0.0001). Anti-malarial use among these children decreased from 19% in 2010 to 10% in 2021 (trend test p < 0.0001), accompanied by an increase in ACT use (2% in 2010 to 8% in 2021; trend test p < 0.0001). Overall, among children who had experienced fever, 30.6% of survey RDT-positive and 36.1% of survey RDT-negative children had received anti-malarials. The proportion of anti-malarials obtained from the private sector increased from 61.8% in 2010 to 80.1% in 2021 for RDT-positive children; most of the anti-malarials received in 2021 were artemisinin-based combinations. Factors associated with anti-malarial receipt for both RDT-positive and RDT-negative children included geographic region, greater household wealth, higher maternal education, and older children.
From 2010 to 2021 in Nigeria, both malaria prevalence and anti-malarial treatments among children aged 6-59 months decreased, as RDT availability increased. Among children who had fever in the prior 2 weeks, anti-malarial receipt was similar between children with either positive or negative survey RDT results, indicative of persistent challenges in reducing inappropriate anti-malarials uptake.
尼日利亚是全球疟疾负担最重的国家，抗疟药物常被用于未经寄生虫学确认的疟疾治疗。2012 年，尼日利亚实施了快速诊断检测（RDT），以减少未经疟疾感染的人群使用抗疟药物，并增加使用青蒿素为基础的联合治疗（ACT）来治疗疟疾。本研究旨在调查在 RDT 可用性增加的 12 年期间，6-59 个月儿童接受抗疟药物治疗的情况变化。
本研究使用 2010 年（2012 年实施 RDT 前）、2015 年和 2021 年尼日利亚疟疾指标调查（NMIS）数据进行了一项横断面分析。该分析评估了按调查 RDT 结果和调查前 2 周内发热和抗疟药物/ACT 接受情况评估疟疾的患病率趋势。采用多变量逻辑回归来解释复杂的调查设计，并按调查 RDT 结果（代表近期/当前疟疾感染的替代指标）分层，来评估与抗疟药物接受情况相关的因素。
在一个具有全国代表性的、22802 名 6-59 个月儿童的加权样本中，发热的患病率保持稳定，而确诊疟疾的患病率从 2010 年的 51.2%下降到 2015 年的 44.3%和 2021 年的 38.5%（趋势检验 p<0.0001）。这些儿童中抗疟药物的使用率从 2010 年的 19%下降到 2021 年的 10%（趋势检验 p<0.0001），同时 ACT 的使用率有所增加（2010 年为 2%，2021 年为 8%；趋势检验 p<0.0001）。总体而言，在经历发热的儿童中，30.6%的 RDT 阳性和 36.1%的 RDT 阴性儿童接受了抗疟药物治疗。RDT 阳性儿童从 2010 年的 61.8%获得的抗疟药物来自私营部门，到 2021 年增加到 80.1%；2021 年获得的大多数抗疟药物都是以青蒿素为基础的联合药物。与 RDT 阳性和 RDT 阴性儿童的抗疟药物接受情况相关的因素包括地理位置、家庭财富水平较高、母亲教育程度较高和年龄较大的儿童。
2010 年至 2021 年，随着 RDT 可用性的增加，尼日利亚 6-59 个月儿童的疟疾患病率和抗疟药物治疗率均有所下降。在过去 2 周内有发热的儿童中，RDT 阳性和 RDT 阴性儿童的抗疟药物接受率相似，表明在减少不合理使用抗疟药物方面仍存在持续挑战。
