EPIDEMIOLOGY OF CLINICAL MALARIA IN WESTERN KENYA HIGHLANDS

肯尼亚西部高地临床疟疾的流行病学

基本信息

批准号：
7936540
负责人：
YAW ASARE AFRANE
金额：
$ 5.4万
依托单位：
KENYA MEDICAL RESEARCH INSTITUTE (KEMRI)
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-02-15 至 2016-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7936540
关键词：
Affect Africa Africa South of the Sahara African Age Antimalarials Area Artemisinins Behavior Breeding Case-Control Studies Child Clinic Clinical Clinical Data Clinical Distribution Combined Modality Therapy Communities Culicidae Data Data Sources Databases Diagnosis Drug resistance Epidemic Epidemiology Error Sources Foundations Funding Genotype Habitats Home environment Hospitals Household Housing Impact evaluation Incidence Individual Infection Insecticides Intervention Kenya Knowledge Link Location Malaria Measures Methods Molecular Analysis Monitor Morbidity - disease rate Parasites Prevalence Program Evaluation Public Health Research Residual state Risk Risk Factors Sahara Sea Site Socioeconomic Factors Source Testing Travel Treatment Effectiveness Uncertainty artemisinine base clinical epidemiology combat cost effective design effective intervention experience fighting improved intervention program killings novel programs vector vector control

项目摘要

DESCRIPTION (provided by applicant): Epidemiology of Clinical Malaria in Western Kenya Highlands Malaria is a major public health problem in Africa. An estimated one million people in Africa die from malaria each year, with the majority of fatalities occurring in children under the age of 5 in areas south of the Sahara. The African highlands (areas with elevation above 1500 m above sea level), where malaria used to be absent or very limited, has experienced periodic epidemics since the 1980's, with more than 110,000 fatalities each year. With the support of Global Funds to Fight Malaria, Presidential Malaria Initiatives and other private foundations, intensive control efforts were initiated in 2006 in Kenya. These efforts included large-scale distribution of insecticide treated nets, indoor residual spraying, and the use of artemisinin- based combination therapy (ACT) to treat uncomplicated malaria. Although these control measures appear successful in reducing malaria prevalence and incidence, there is no rigorous monitoring and evaluation program for these efforts because data on malaria prevalence and incidence are often difficult or too expensive to obtain on a large geographic scale. While hospital-based data is available, and an inexpensive source of data, there is uncertainty about the reliability of this data source. Additionally, clinical malaria incidence in the highland regions of western Kenya remains so high that intensive vector control measures and new antimalarial treatment regimes are being implemented. The objectives of this application are to determine the reliability of hospital-based malaria case data for representing natural malaria incidence and for the usefulness of this data in impact evaluation of malaria control measures, and to determine the risk factors for clinical malaria infection in areas undergoing intensive malaria intervention. I have designed two specific aims. The first specific aim tests the hypothesis that misdiagnosis, home treatment and hospital treatment-seeking behaviour are the major sources of errors in hospital-based malaria case data for representing natural malaria incidence rates. The second specific aim tests the hypothesis that clinical malaria infection risk in individual households may be affected by biotic and abiotic factors, and socioeconomic matters, and the importance of the risk factors for clinical malaria may be determined by using case-control studies. This research will answer important questions such as whether hospital-based malaria case data are suitable for malaria incidence monitoring and impact evaluation of malaria control efforts, and will help to develop new methods that target the important risk factors for clinical malaria in the era of intensive malaria control in Africa. PUBLIC HEALTH RELEVANCE: Epidemic malaria in the African highlands kills about 110,000 people each year and 110 million people are at risk of malaria infection. Understanding the risk factors for clinical malaria infection in the highlands will help to develop cost-effective interventions to combat malaria epidemics. The accuracy and sensitivity of hospital-based clinical malaria data is essential to measure the impact of malaria interventions.

描述（由申请人提供）：肯尼亚西部高地疟疾的临床疟疾流行病学是非洲的主要公共卫生问题。估计每年有100万人死于疟疾，大部分死亡发生在撒哈拉以南地区5岁以下的儿童中。自1980年代以来，疟疾曾经缺乏或非常有限的非洲高地（海拔高于海平面1500 m的地区）每年经历了周期性流行病，每年有超过110,000人的死亡。在全球资金与疟疾，总统疟疾倡议和其他私人基金会作斗争的支持下，2006年在肯尼亚发起了密集的控制努力。这些努力包括大规模的杀虫剂处理的网，室内残留喷涂以及使用基于青蒿素的联合疗法（ACT）来治疗简单的疟疾。尽管这些控制措施在降低疟疾的患病率和发病率方面似乎很成功，但是对于这些努力，没有严格的监测和评估计划，因为有关疟疾患病率和发病率的数据通常很难或太昂贵，无法在大地理范围内获得。尽管可以使用基于医院的数据，并且是廉价的数据来源，但此数据源的可靠性存在不确定性。此外，肯尼亚西部高地地区的临床疟疾发病率仍然很高，以至于强化载体控制措施和新的抗疟疾治疗方案正在实施。本应用的目的是确定用于代表自然疟疾发病率的医院疟疾病例数据的可靠性，以及该数据在影响疟疾控制措施的影响评估中的有用性，并确定强化疟疾干预的地区临床疟疾感染的危险因素。我设计了两个具体的目标。第一个特定目的检验了误诊，家庭治疗和寻求治疗行为的假设是用于代表自然疟疾发病率的医院疟疾病例数据中错误的主要来源。第二个特定目的检验了以下假设：个体家庭的临床疟疾感染风险可能会受到生物和非生物因素以及社会经济问题的影响，并且可以通过使用病例控制研究来确定危险因素对临床疟疾的重要性。这项研究将回答重要的问题，例如，基于医院的疟疾病例数据是否适合疟疾的发生率监测和影响疟疾控制工作的评估，并将有助于开发针对非洲强化疟疾时代临床疟疾重要风险因素的新方法。公共卫生相关性：非洲高地的流行疟疾每年造成约110,000人，有1.1亿人有疟疾感染的风险。了解高地临床疟疾感染的危险因素将有助于开发具有成本效益的干预措施，以打击疟疾流行病。基于医院的临床疟疾数据的准确性和敏感性对于衡量疟疾干预的影响至关重要。