前往肯尼亚旅行者的疟疾化学预防效果及其他决定因素

Effectiveness of chemoprophylaxis and other determinants of malaria in travellers to Kenya.

作者信息

Muehlberger N, Jelinek T, Schlipkoeter U, von Sonnenburg F, Nothdurft H D

机构信息

Department of Public Health and Epidemiology, University of Munich, Germany.

出版信息

Trop Med Int Health. 1998 May;3(5):357-63. doi: 10.1046/j.1365-3156.1998.00235.x.

DOI:10.1046/j.1365-3156.1998.00235.x

PMID:9623940

Abstract

OBJECTIVE

To investigate the effectiveness of chemoprophylaxis and the determinants of malaria importation from Kenya.

METHOD

In a population-based case-control study, 51 travellers from Bavaria diagnosed with falciparum malaria imported from Kenya (cases) and a sample of 383 healthy Bavarian travellers returning from Kenya (controls) were interviewed. Data were analysed by multiple logistic regression.

RESULTS

Mefloquine (OR = 0.055; 95% CI 0.019-0.16) and chloroquine combined with proguanil (OR = 0.128; 95% CI 0.039-0.419) were highly protective against P. falciparum malaria, whereas other drugs were ineffective (OR = 1.225; 95% CI 0.536-2.803). Ineffective prophylaxis (10.4%) and non-prophylaxis (11.2%) were the main reasons for malaria importation. Travelling alone or with friends, male sex, and travel duration over 4 weeks could be identified as additional risk factors. The main reason for inadequate chemoprophylaxis was inappropriate medical advice (87.5%). Prophylaxis refusal occurred frequently despite correct advice (58.1%). Diagnosis was often delayed unnecessarily (27.5%).

CONCLUSION

Malaria importation from Kenya could be reduced substantially (34%) by eliminating inappropriate medical advice.

摘要

目的

调查化学预防的有效性以及从肯尼亚输入疟疾的决定因素。

方法

在一项基于人群的病例对照研究中，对51名来自巴伐利亚州、被诊断为从肯尼亚输入的恶性疟原虫疟疾的旅行者（病例）以及383名从肯尼亚返回的健康巴伐利亚旅行者样本（对照）进行了访谈。通过多因素逻辑回归分析数据。

结果

甲氟喹（比值比[OR]=0.055；95%可信区间[CI]0.019 - 0.16）以及氯喹与氯胍联合使用（OR = 0.128；95% CI 0.039 - 0.419）对恶性疟原虫疟疾具有高度保护作用，而其他药物则无效（OR = 1.225；95% CI 0.536 - 2.803）。无效预防（10.4%）和未预防（11.2%）是疟疾输入的主要原因。独自旅行或与朋友同行、男性以及旅行时间超过4周可被确定为额外的风险因素。化学预防不足的主要原因是不恰当的医疗建议（87.5%）。尽管有正确建议，仍经常出现预防措施被拒绝的情况（58.1%）。诊断常常被不必要地延迟（27.5%）。