Nsekuye Olivier, Malamba Samuel S, Omolo Jared, El-Khatib Ziad, Mangara Jean-Louis N, Munyakanage Dunia, Umutoni Angela, Lucchi Naomi W, Rwagasore Edson, Rwunganira Samuel, Uwimana Aline, Ntabanganyimana Daniel, Niyoyita Jean-Claude, Uwayo Henri Desire, Ntakirutimana Theoneste
Rwanda Biomedical Centre (RBC), Public Health Surveillance & Emergency Preparedness and Response Division, P.O. Box 7162, Kigali, Rwanda.
US Centers for Disease Control and Prevention, Global Health Center, Division of Global HIV & TB, Rwanda Country Office, 30 KG 7 Avenue Kacyiru, P.O. Box 28, Kigali, Rwanda.
Malar J. 2024 Dec 18;23(1):381. doi: 10.1186/s12936-024-05194-5.
Indoor residual spraying (IRS) has been implemented in Rwanda in districts with high malaria transmission, including Ngoma District. The first IRS campaign (IRS-1) was conducted in March 2019, ahead of the peak malaria season, followed by a second campaign (IRS-2) in August 2020, targeting 89,331 structures. This study assessed factors influencing IRS uptake and evaluated the impact of IRS interventions on malaria morbidity in Ngoma District, Eastern Province, Rwanda.
A household survey employing multistage cluster sampling design was conducted in May 2021 to randomly select households. A structured questionnaire was administered to the head of household or a designated representative. Logistic regression, adjusted for the complex survey design and weighted for sampling, was used to identify factors associated with IRS uptake. Additionally, secondary data on malaria cases registered in the Rwanda Health Management Information System (RHMIS) from January 2015 to December 2022 were analyzed using interrupted time series analysis to evaluate the effect of IRS on malaria morbidity.
A total of 636 households participated in the survey. Households headed by self-employed individuals (aOR = 0.07; 95% CI 0.01-0.55) and unemployed individuals (aOR = 0.18; 95% CI 0.03-0.99) were less likely to take up IRS compared to those headed by farmers. Households receiving IRS information through media channels (aOR = 0.01; 95% CI 0.00-0.17) were less likely to participate compared to those informed by community health workers. From the RHMIS data, 919,843 malaria cases were identified from January 2015 to December 2022. Interrupted time series analysis revealed that the baseline number of adjusted malaria cases was approximately 16,920. The first IRS intervention in March 2019 resulted in a significant reduction of 14,380 cases (p < 0.001), while the second intervention in August 2020 led to a reduction of 2495 cases, though this was not statistically significant (p = 0.098).
This study demonstrates the effectiveness of IRS in reducing malaria incidence in Ngoma District and highlights the role of socioeconomic factors and sources of information in influencing IRS uptake. To maximize the impact of IRS and ensure equitable benefits, targeted strategies, enhanced IRS education, and integrated malaria control approaches, including the use of bed nets, are crucial.
卢旺达已在包括恩戈马区在内的疟疾传播率高的地区实施室内滞留喷洒（IRS）。首次IRS活动（IRS-1）于2019年3月在疟疾高发季节之前开展，随后在2020年8月开展了第二次活动（IRS-2），目标是89,331处建筑。本研究评估了影响IRS采用率的因素，并评估了IRS干预措施对卢旺达东部省恩戈马区疟疾发病率的影响。
2021年5月采用多阶段整群抽样设计进行了一项家庭调查，以随机选择家庭。向户主或指定代表发放了一份结构化问卷。采用逻辑回归分析，对复杂的调查设计进行调整并加权抽样，以确定与IRS采用相关的因素。此外，使用中断时间序列分析对2015年1月至2022年12月在卢旺达卫生管理信息系统（RHMIS）中登记的疟疾病例的二次数据进行分析，以评估IRS对疟疾发病率的影响。
共有636户家庭参与了调查。与以农民为户主的家庭相比，以个体经营者为户主的家庭（调整后比值比[aOR]=0.07；95%置信区间[CI]为0.01-0.55）和失业者为户主的家庭（aOR=0.18；95%CI为0.03-0.99）采用IRS的可能性较小。与通过社区卫生工作者获得IRS信息的家庭相比，通过媒体渠道获得IRS信息的家庭（aOR=0.01；95%CI为0.00-0.17）参与的可能性较小。从RHMIS数据中，2015年1月至2022年12月共识别出919,843例疟疾病例。中断时间序列分析显示，调整后的疟疾病例基线数量约为16,920例。2019年3月的首次IRS干预使病例数显著减少了14,380例（p<0.001），而2020年8月的第二次干预使病例数减少了2495例，尽管这在统计学上不显著（p=0.098）。
本研究证明了IRS在降低恩戈马区疟疾发病率方面的有效性，并强调了社会经济因素和信息来源在影响IRS采用率方面的作用。为了最大限度地发挥IRS的影响并确保公平受益，针对性策略、加强IRS教育以及包括使用蚊帐在内的综合疟疾控制方法至关重要。
