多米尼加共和国疟疾传播热点地区长效驱虫蚊帐分发后监测调查的见解：对量化和分发策略的影响
Insights from LLIN post-distribution monitoring surveys in the malaria transmission foci of the Dominican Republic: implications for quantification and distribution strategies.
作者信息
Ventura Gilda, Félix María Yinet Santos, Bueno Natalia Tejada, Ströfer Nicole Michelén, Raposo Jose Luis Cruz, Solís Ángel, Parra Rafael German Barrios, Montoya Lucía Fernández
机构信息
Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis (CECOVEZ), Santo Domingo, Dominican Republic.
Clinton Health Access Initiative (CHAI), Boston, MA, USA.
出版信息
Malar J. 2025 Aug 21;24(1):272. doi: 10.1186/s12936-025-05406-6.
BACKGROUND
Long-lasting insecticidal nets (LLINs) have been distributed and installed in the Dominican Republic since 2008, and they remain the main vector control intervention used to pursue malaria elimination in the country. However, LLIN performance remains unclear due to a lack of monitoring over the past decade.
METHODS
A cross-sectional household survey was conducted to monitor LLIN coverage, access, use, physical integrity, washing and drying practices, and the time people go to bed and wake up in the two main malaria foci of the country: Azua (4-6 months post-distribution and installation) and San Juan (one year post-distribution and installation).
RESULTS
The percentage of sleeping spaces that could be covered with a LLIN given the LLINs present in the household was 64% in Azua and 63% in San Juan; with any net, coverage was 75% in Azua and 80% in San Juan. Reported LLIN retention was 88.4% in Azua and 80.9% in San Juan. The percentage of people who had access to sleeping under an LLIN was 58.8% in Azua and 65.4% in San Juan. Among people with LLIN access (people with enough LLINs to cover all sleeping spaces in their household), use was 48.8% in Azua and 75% in San Juan; and overall, LLINs use was 32.3% in Azua and 50.5% in San Juan. Most LLINs remained in serviceable physical condition (Azua: 96.4%, San Juan: 88.9%) but those with holes were not repaired. Most LLINs were washed with aggressive products (Azua: 65%, San Juan: 86%), at a frequency that suggests they will be washed more than twenty times in three years (Azua: 52%, San Juan: 73%), and dried under the sun (Azua: 75%, San Juan: 90%).
CONCLUSION
Poor washing and drying practices are prevalent in both areas, low LLIN use was observed in Azua and some LLIN coverage gaps were measured in both foci. Urgent behavioural change strategies are needed to improve LLIN care in both foci and to increase LLIN use in Azua, alongside revisions to LLIN quantification methods to ensure full coverage of all sleeping spaces in use during installation. Heterogeneities in LLINs use across foci suggest the need for monitoring use in each distribution area to identify individual gaps and promptly address them.
背景
自2008年以来，多米尼加共和国已分发并安装了长效驱虫蚊帐（LLINs），它们仍然是该国为实现疟疾消除而采用的主要病媒控制干预措施。然而，由于过去十年缺乏监测，LLINs的性能仍不明确。
方法
开展了一项横断面家庭调查，以监测该国两个主要疟疾高发地区（阿苏阿[分发和安装后4 - 6个月]和圣胡安[分发和安装后一年]）的LLINs覆盖率、可及性、使用情况、物理完整性、洗涤和干燥习惯，以及人们上床睡觉和起床的时间。
结果
根据家庭中现有的LLINs，阿苏阿可被LLIN覆盖的睡眠空间比例为64%，圣胡安为63%；使用任何蚊帐时，阿苏阿的覆盖率为75%，圣胡安为80%。报告的阿苏阿LLIN留存率为88.4%，圣胡安为80.9%。有机会在LLIN下睡觉的人群比例，阿苏阿为58.8%，圣胡安为65.4%。在有LLIN可及性的人群（拥有足够LLINs覆盖其家庭所有睡眠空间的人）中，阿苏阿的使用率为48.8%，圣胡安为75%；总体而言，阿苏阿的LLINs使用率为32.3%，圣胡安为50.5%。大多数LLINs仍处于可用的物理状态（阿苏阿：96.4%，圣胡安：88.9%），但有破洞的蚊帐未得到修复。大多数LLINs使用强效产品洗涤（阿苏阿：65%，圣胡安：86%），洗涤频率表明它们将在三年内洗涤超过二十次（阿苏阿：52%，圣胡安：73%），并在阳光下晾干（阿苏阿：75%，圣胡安：90%）。
结论
两个地区普遍存在不良的洗涤和干燥习惯，在阿苏阿观察到LLINs使用率较低，且在两个高发地区均测量到一些LLINs覆盖缺口。需要采取紧急行为改变策略，以改善两个高发地区的LLINs护理，并提高阿苏阿的LLINs使用率，同时修订LLINs量化方法，以确保在安装期间全面覆盖所有使用中的睡眠空间。不同高发地区LLINs使用情况的异质性表明，需要监测每个分发地区的使用情况，以识别个体缺口并及时解决。
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