2021年乌干达科蒂多和莫罗托地区季节性疟疾化学预防对五岁以下儿童疟疾发病率的影响：时间序列分析

Effect of seasonal malaria chemoprevention on incidence of malaria among children under five years in Kotido and Moroto Districts, Uganda, 2021: time series analysis.

作者信息

Kwiringira Andrew, Kwesiga Benon, Migisha Richard, Bulage Lilian, Kadobera Daniel, Rutazaana Damian, Harris Julie R, Ario Alex R, Ssempiira Julius

机构信息

Uganda Public Health Fellowship Programme, Kampala, Uganda.

Department of Planning Financing and Policy, Ministry of Health, Kampala, Uganda.

出版信息

Malar J. 2024 Dec 18;23(1):389. doi: 10.1186/s12936-024-05220-6.

DOI:10.1186/s12936-024-05220-6

PMID:39695723

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11657844/

Abstract

BACKGROUND

Seasonal malaria chemoprevention (SMC) refers to monthly administration of full treatment courses of anti-malarial medicine to children <5 years during high malaria transmission seasons. SMC has demonstrated effectiveness in Sahel and sub-Sahel countries in Africa. However, it was not implemented in Uganda until April 2021, when the country began SMC in the highly malaria-endemic Kotido and Moroto Districts. This study assessed the effect of SMC on malaria incidence among children <5 years of age in Kotido and Moroto Districts.

METHODS

An interrupted time-series analysis was conducted using monthly national health data from the Uganda Ministry of Health District Health Information System 2. The monthly data for outpatient (uncomplicated) malaria among children <5 years was extracted for the 52 months before SMC implementation (Jan 2017-Apr 2021) and 8 months during SMC implementation (May-Dec 2021). The monthly incidence of uncomplicated malaria per 1000 children <5 years was computed before and during SMC implementation.

RESULTS

In Kotido District, malaria incidence was 693/1000 during SMC implementation period, compared to an expected 1216/1000 if SMC had not been implemented. The mean monthly malaria incidence was 87/1000, compared to an expected mean of 152/1000 if SMC had not been implemented. This represents a statistically significant mean monthly change of -65.4 (95% CI = -104.6, -26.2) malaria cases/1000 during SMC implementation, or a 43.0% decline. In Moroto District, malaria incidence was 713/1000 during SMC implementation period, compared to an expected 905/1000 if SMC had not been implemented. The mean monthly malaria incidence was 89/1000, compared to an expected 113/1000 if SMC had not been deployed. This represents a statistically significant mean monthly change of -24.0 (95% CI = -41.1, -6.8) malaria cases/1000 during SMC implementation, or a 21.2% decline.

CONCLUSION

Implementation of SMC substantially reduced the incidence of uncomplicated malaria among children <5 years in Moroto and Kotido Districts. Scaling up SMC in other districts with high malaria transmission could reduce malaria on a large scale across Uganda.

摘要

背景

季节性疟疾化学预防（SMC）是指在疟疾高传播季节，每月为5岁以下儿童提供完整疗程的抗疟药物治疗。SMC在非洲的萨赫勒和次萨赫勒国家已证明有效。然而，直到2021年4月乌干达才开始实施SMC，当时该国在疟疾高度流行的科蒂多和莫罗托地区启动了SMC。本研究评估了SMC对科蒂多和莫罗托地区5岁以下儿童疟疾发病率的影响。

方法

使用乌干达卫生部地区卫生信息系统2的月度国家卫生数据进行中断时间序列分析。提取了实施SMC前52个月（2017年1月至2021年4月）和实施SMC期间8个月（2021年5月至12月）5岁以下儿童门诊（非重症）疟疾的月度数据。计算了实施SMC前后每1000名5岁以下儿童非重症疟疾的月度发病率。

结果

在科蒂多地区，实施SMC期间疟疾发病率为693/1000，而如果未实施SMC，预计发病率为1216/1000。平均每月疟疾发病率为87/1000，而如果未实施SMC，预计平均发病率为152/1000。这表明在实施SMC期间，每1000人每月疟疾病例数有统计学意义的平均变化为-65.4（95%CI=-104.6，-26.2），即下降了43.0%。在莫罗托地区，实施SMC期间疟疾发病率为713/1000，而如果未实施SMC，预计发病率为905/1000。平均每月疟疾发病率为89/1000，而如果未部署SMC，预计发病率为113/1000。这表明在实施SMC期间，每1000人每月疟疾病例数有统计学意义的平均变化为-24.0（95%CI=-41.1，-6.8），即下降了21.2%。