PDF(Pubmed)
Abstract：
BACKGROUND: A major challenge to malaria elimination is identifying and targeting populations that are harbouring residual infections and contributing to persistent transmission. In many near-elimination settings in Southeast Asia, it is known that forest-goers are at higher risk for malaria infection, but detailed information on their behaviours and exposures is not available.
METHODS: In Aceh Province, Indonesia, a near-elimination setting where a growing proportion of malaria is due to Plasmodium knowlesi, a case-control study was conducted to identify risk factors for symptomatic malaria, characteristics of forest-goers, and key intervention points. From April 2017 to September 2018, cases and controls were recruited and enrolled in a 1:3 ratio. Cases had confirmed malaria infection by rapid diagnostic test or microscopy detected at a health facility (HF). Gender-matched controls were recruited from passive case detection among individuals with suspected malaria who tested negative at a health facility (HF controls), and community-matched controls were recruited among those testing negative during active case detection. Multivariable logistic regression (unconditional for HF controls and conditional for community controls) was used to identify risk factors for symptomatic malaria infection.
RESULTS: There were 45 cases, of which 27 were P. knowlesi, 17 were Plasmodium vivax, and one was not determined. For controls, 509 and 599 participants were recruited from health facilities and the community, respectively. Forest exposures were associated with high odds of malaria; in particular, working and sleeping in the forest (HF controls: adjusted odds ratio (aOR) 21.66, 95% CI 5.09-92.26; community controls: aOR 16.78, 95% CI 2.19-128.7) and having a second residence in the forest (aOR 6.29, 95% CI 2.29-17.31 and 13.53, 95% CI 2.10-87.12). Male forest-goers were a diverse population employed in a variety of occupations including logging, farming, and mining, sleeping in settings, such as huts, tents, and barracks, and working in a wide range of group sizes. Reported use of protective measures, such as nets, hammock nets, mosquito coils, and repellents was low among forest-goers and interventions at forest residences were absent.
CONCLUSIONS: Second residences in the forest and gaps in use of protective measures point to key malaria interventions to improve coverage in forest-going populations at risk for P. knowlesi and P. vivax in Aceh, Indonesia. Intensified strategies tailored to specific sub-populations will be essential to achieve elimination.
METHODS: In Aceh Province, Indonesia, a near-elimination setting where a growing proportion of malaria is due to Plasmodium knowlesi, a case-control study was conducted to identify risk factors for symptomatic malaria, characteristics of forest-goers, and key intervention points. From April 2017 to September 2018, cases and controls were recruited and enrolled in a 1:3 ratio. Cases had confirmed malaria infection by rapid diagnostic test or microscopy detected at a health facility (HF). Gender-matched controls were recruited from passive case detection among individuals with suspected malaria who tested negative at a health facility (HF controls), and community-matched controls were recruited among those testing negative during active case detection. Multivariable logistic regression (unconditional for HF controls and conditional for community controls) was used to identify risk factors for symptomatic malaria infection.
RESULTS: There were 45 cases, of which 27 were P. knowlesi, 17 were Plasmodium vivax, and one was not determined. For controls, 509 and 599 participants were recruited from health facilities and the community, respectively. Forest exposures were associated with high odds of malaria; in particular, working and sleeping in the forest (HF controls: adjusted odds ratio (aOR) 21.66, 95% CI 5.09-92.26; community controls: aOR 16.78, 95% CI 2.19-128.7) and having a second residence in the forest (aOR 6.29, 95% CI 2.29-17.31 and 13.53, 95% CI 2.10-87.12). Male forest-goers were a diverse population employed in a variety of occupations including logging, farming, and mining, sleeping in settings, such as huts, tents, and barracks, and working in a wide range of group sizes. Reported use of protective measures, such as nets, hammock nets, mosquito coils, and repellents was low among forest-goers and interventions at forest residences were absent.
CONCLUSIONS: Second residences in the forest and gaps in use of protective measures point to key malaria interventions to improve coverage in forest-going populations at risk for P. knowlesi and P. vivax in Aceh, Indonesia. Intensified strategies tailored to specific sub-populations will be essential to achieve elimination.
摘要：
背景：消除疟疾的一个主要挑战是识别和瞄准那些携带残留感染并导致持续传播的人群。在东南亚的许多接近淘汰的环境中，众所周知，森林居民感染疟疾的风险更高，但是关于他们的行为和暴露的详细信息是不可用的。
方法：在亚齐省，印度尼西亚,在接近消灭的环境中，疟疾的比例越来越多是由诺氏疟原虫引起的，进行了一项病例对照研究，以确定有症状的疟疾的危险因素，森林居民的特点，和关键干预要点。从2017年4月至2018年9月，病例和对照以1:3的比例招募和登记。病例通过在医疗机构（HF）检测到的快速诊断测试或显微镜确认了疟疾感染。在医疗机构（HF对照）检测为阴性的疑似疟疾患者的被动病例检测中招募了性别匹配的对照，并且在主动病例检测期间检测阴性的人群中招募了社区匹配的对照。使用多变量逻辑回归（HF对照组为无条件，社区对照组为有条件）来确定有症状的疟疾感染的危险因素。
结果：45例，其中27人是P.Knowlesi，17个是间日疟原虫，一个人没有确定。对于控件，从医疗机构和社区招募了509名和599名参与者，分别。森林暴露与疟疾的高几率相关；特别是，在森林中工作和睡觉(HF对照:调整后比值比(aOR)21.66,95%CI5.09-92.26;社区对照:aOR16.78,95%CI2.19-128.7)和在森林中拥有第二居住地(aOR6.29,95%CI2.29-17.31和13.53,95%CI2.10-87.12).男性森林砍伐者是从事各种职业的多样化人口，包括伐木，农业,采矿,在设置中睡觉，比如小屋，帐篷,和兵营，并在广泛的群体规模中工作。报告使用了保护措施，比如网，吊床网,蚊香,森林居民中的驱避剂较低，缺乏对森林居民的干预措施。
结论：森林中的第二个住所和使用保护措施的差距指出了关键的疟疾干预措施，以提高亚齐地区有诺氏疟原虫和间日疟原虫风险的森林人口的覆盖率，印度尼西亚。针对特定亚群体的强化战略对于实现消除至关重要。
方法：在亚齐省，印度尼西亚,在接近消灭的环境中，疟疾的比例越来越多是由诺氏疟原虫引起的，进行了一项病例对照研究，以确定有症状的疟疾的危险因素，森林居民的特点，和关键干预要点。从2017年4月至2018年9月，病例和对照以1:3的比例招募和登记。病例通过在医疗机构（HF）检测到的快速诊断测试或显微镜确认了疟疾感染。在医疗机构（HF对照）检测为阴性的疑似疟疾患者的被动病例检测中招募了性别匹配的对照，并且在主动病例检测期间检测阴性的人群中招募了社区匹配的对照。使用多变量逻辑回归（HF对照组为无条件，社区对照组为有条件）来确定有症状的疟疾感染的危险因素。
结果：45例，其中27人是P.Knowlesi，17个是间日疟原虫，一个人没有确定。对于控件，从医疗机构和社区招募了509名和599名参与者，分别。森林暴露与疟疾的高几率相关；特别是，在森林中工作和睡觉(HF对照:调整后比值比(aOR)21.66,95%CI5.09-92.26;社区对照:aOR16.78,95%CI2.19-128.7)和在森林中拥有第二居住地(aOR6.29,95%CI2.29-17.31和13.53,95%CI2.10-87.12).男性森林砍伐者是从事各种职业的多样化人口，包括伐木，农业,采矿,在设置中睡觉，比如小屋，帐篷,和兵营，并在广泛的群体规模中工作。报告使用了保护措施，比如网，吊床网,蚊香,森林居民中的驱避剂较低，缺乏对森林居民的干预措施。
结论：森林中的第二个住所和使用保护措施的差距指出了关键的疟疾干预措施，以提高亚齐地区有诺氏疟原虫和间日疟原虫风险的森林人口的覆盖率，印度尼西亚。针对特定亚群体的强化战略对于实现消除至关重要。
