Thiam Tidiane, Kande Demba, Ntuku Henry, Guinovart Caterina, Galles Natalie, Merriman Laura, Cissé Moustapha, Sall Abiboulaye, Diop Ndack, Diouf Aichatou Barry, Diaw Mama Moussa, Diop Mamadou, Camara Baba, Seck Niene, Ndour Aliou, Dieye Yakou, Smith Jennifer, Bennett Adam
PATH, Seattle, USA.
Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
Malar J. 2024 Dec 18;23(1):373. doi: 10.1186/s12936-024-05219-z.
Senegal has made significant progress in reducing the burden of malaria, but transmission remains highly heterogeneous, with specific population subgroups likely at higher risk. Consultations with the National Malaria Control Programme (NMCP) and a review of available data identified nomadic pastoralists, gold miners, and Koranic school students as potential high-risk populations (HRPs). This study aimed to evaluate whether these populations are at higher risk of malaria and better characterize their exposure patterns to inform the design of targeted intervention strategies.
A mixed-methods study was conducted in the districts of Ranérou, Kaolack, and Saraya between November 2020 and December 2021. A formative assessment including key informant interviews (KII) and focus group discussions (FGD) was conducted with non-HRP and HRP members (nomadic pastoralists, gold miners, Koranic school students). A health facility-based case-control study was then conducted in nine health facilities across the three districts. 501 confirmed malaria cases and 1002 non-malaria controls were frequency matched by age and sex with a ratio of 1:2. A standardized questionnaire was administered to collect sociodemographic information, including occupation, use of malaria prevention measures, mosquito exposure, and travel history. Multivariable logistic regression was used to identify malaria risk factors.
KIIs and FGDs indicated that nomadic pastoralists, gold miners and Koranic school students have high exposure to mosquito bites through outdoor sleeping, spending time outside at night and sleeping in informal structures, with important gaps in the coverage of indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) and limited access to health services. Compared to controls, cases had higher odds of being a nomadic pastoralist (odds ratio (OR) 4.67 95% CI 1.96-11.11) or gold miner (OR 1.92 95% CI 1.20-3.07). No evidence was found of an association with being a Koranic school student (OR 1.39 95% CI 0.80-2.39).
Nomadic pastoralists and gold miners in the study areas are at higher risk of malaria. Targeted interventions are needed to cover gaps in malaria prevention coverage and access to health services.
塞内加尔在减轻疟疾负担方面取得了重大进展，但疟疾传播仍然高度不均一，特定人群亚组可能面临更高风险。与国家疟疾控制规划（NMCP）进行的磋商以及对现有数据的审查确定游牧牧民、金矿工人和古兰经学校学生为潜在的高风险人群（HRP）。本研究旨在评估这些人群是否面临更高的疟疾风险，并更好地描述他们的暴露模式，以为有针对性的干预策略设计提供依据。
2020年11月至2021年12月期间，在拉内鲁、考拉克和萨拉亚地区开展了一项混合方法研究。对非高风险人群和高风险人群（游牧牧民、金矿工人、古兰经学校学生）进行了包括关键信息人访谈（KII）和焦点小组讨论（FGD）在内的形成性评估。然后在这三个地区的九家医疗机构开展了一项一项基于医疗机构的病例对照研究。501例确诊疟疾病例和1002例非疟疾对照按年龄和性别进行频数匹配，比例为1:2。采用标准化问卷收集社会人口学信息，包括职业、疟疾预防措施使用情况、蚊虫暴露情况和旅行史。采用多变量logistic回归确定疟疾危险因素。
关键信息人访谈和焦点小组讨论表明，游牧牧民、金矿工人和古兰经学校学生因在户外睡眠、夜间外出活动以及在非正式建筑中睡觉而高度暴露于蚊虫叮咬，在室内滞留喷洒（IRS）和长效驱虫蚊帐（LLIN）的覆盖方面存在重大差距，获得卫生服务的机会有限。与对照相比，病例为游牧牧民（比值比（OR）4.67，95%置信区间1.96 - 11.11）或金矿工人（OR 1.92，95%置信区间1.20 - 3.07）的几率更高。未发现与古兰经学校学生存在关联的证据（OR 1.39，95%置信区间0.80 - 2.39）。
研究地区的游牧牧民和金矿工人面临更高的疟疾风险。需要采取有针对性的干预措施来弥补疟疾预防覆盖和获得卫生服务方面的差距。
