PDF(Pubmed)
Abstract：
BACKGROUND: While substantial gains have been made in the fight against malaria over the past 20 years, malaria morbidity and mortality are marked by inequality. The equitable elimination of malaria within countries will be determined in part by greater spending on malaria interventions, and how those investments are allocated. This study aims to identify potential drivers of malaria outcome inequality and to demonstrate how spending through different mechanisms might lead to greater health equity.
METHODS: Using the Gini index, subnational estimates of malaria incidence and mortality rates from 2010 to 2020 were used to quantify the degree of inequality in malaria burden within countries with incidence rates above 5000 cases per 100,000 people in 2020. Estimates of Gini indices represent within-country distributions of disease burden, with high values corresponding to inequitable distributions of malaria burden within a country. Time series analyses were used to quantify associations of malaria inequality with malaria spending, controlling for country socioeconomic and population characteristics.
RESULTS: Between 2010 and 2020, varying levels of inequality in malaria burden within malaria-endemic countries was found. In 2020, values of the Gini index ranged from 0.06 to 0.73 for incidence, 0.07 to 0.73 for mortality, and 0.00 to 0.36 for case fatality. Greater total malaria spending, spending on health systems strengthening for malaria, healthcare access and quality, and national malaria incidence were associated with reductions in malaria outcomes inequality within countries. In addition, government expenditure on malaria, aggregated government and donor spending on treatment, and maternal educational attainment were also associated with changes in malaria outcome inequality among countries with the greatest malaria burden.
CONCLUSIONS: The findings from this study suggest that prioritizing health systems strengthening in malaria spending and malaria spending in general especially from governments will help to reduce inequality of the malaria burden within countries. Given heterogeneity in outcomes in countries currently fighting to control malaria, and the challenges in increasing both domestic and international funding allocated to control and eliminate malaria, the efficient targeting of limited resources is critical to attain global malaria eradication goals.
METHODS: Using the Gini index, subnational estimates of malaria incidence and mortality rates from 2010 to 2020 were used to quantify the degree of inequality in malaria burden within countries with incidence rates above 5000 cases per 100,000 people in 2020. Estimates of Gini indices represent within-country distributions of disease burden, with high values corresponding to inequitable distributions of malaria burden within a country. Time series analyses were used to quantify associations of malaria inequality with malaria spending, controlling for country socioeconomic and population characteristics.
RESULTS: Between 2010 and 2020, varying levels of inequality in malaria burden within malaria-endemic countries was found. In 2020, values of the Gini index ranged from 0.06 to 0.73 for incidence, 0.07 to 0.73 for mortality, and 0.00 to 0.36 for case fatality. Greater total malaria spending, spending on health systems strengthening for malaria, healthcare access and quality, and national malaria incidence were associated with reductions in malaria outcomes inequality within countries. In addition, government expenditure on malaria, aggregated government and donor spending on treatment, and maternal educational attainment were also associated with changes in malaria outcome inequality among countries with the greatest malaria burden.
CONCLUSIONS: The findings from this study suggest that prioritizing health systems strengthening in malaria spending and malaria spending in general especially from governments will help to reduce inequality of the malaria burden within countries. Given heterogeneity in outcomes in countries currently fighting to control malaria, and the challenges in increasing both domestic and international funding allocated to control and eliminate malaria, the efficient targeting of limited resources is critical to attain global malaria eradication goals.
摘要：
背景：尽管在过去的20年中，抗击疟疾取得了实质性进展，疟疾发病率和死亡率的特点是不平等。各国公平消除疟疾将部分取决于增加对疟疾干预措施的支出，以及这些投资是如何分配的。这项研究旨在确定疟疾结果不平等的潜在驱动因素，并证明通过不同机制进行支出可能导致更大的卫生公平。
方法：使用基尼指数，2010年至2020年国家以下各级对疟疾发病率和死亡率的估计用于量化2020年发病率超过每10万人5000例的国家中疟疾负担的不平等程度.基尼系数的估计代表疾病负担的国内分布，高价值对应于一个国家内疟疾负担的不公平分配。时间序列分析用于量化疟疾不平等与疟疾支出的关联，控制国家社会经济和人口特征。
结果：在2010年至2020年期间，疟疾流行国家的疟疾负担存在不同程度的不平等。2020年，基尼系数的发生率在0.06到0.73之间，死亡率为0.07至0.73，病死率为0.00至0.36。疟疾总支出增加，加强疟疾卫生系统的支出，医疗保健准入和质量，和国家疟疾发病率与国家内部疟疾结果不平等的减少有关。此外,政府在疟疾方面的支出，政府和捐助者在治疗方面的综合支出，和孕产妇受教育程度也与疟疾负担最大的国家之间疟疾结局不平等的变化有关。
结论：这项研究的结果表明，优先考虑卫生系统加强疟疾支出和总体疟疾支出，特别是政府的支出，将有助于减少国家内部疟疾负担的不平等。鉴于目前正在努力控制疟疾的国家的结果存在异质性，以及增加用于控制和消除疟疾的国内和国际资金的挑战，有效瞄准有限的资源对于实现全球根除疟疾目标至关重要。
方法：使用基尼指数，2010年至2020年国家以下各级对疟疾发病率和死亡率的估计用于量化2020年发病率超过每10万人5000例的国家中疟疾负担的不平等程度.基尼系数的估计代表疾病负担的国内分布，高价值对应于一个国家内疟疾负担的不公平分配。时间序列分析用于量化疟疾不平等与疟疾支出的关联，控制国家社会经济和人口特征。
结果：在2010年至2020年期间，疟疾流行国家的疟疾负担存在不同程度的不平等。2020年，基尼系数的发生率在0.06到0.73之间，死亡率为0.07至0.73，病死率为0.00至0.36。疟疾总支出增加，加强疟疾卫生系统的支出，医疗保健准入和质量，和国家疟疾发病率与国家内部疟疾结果不平等的减少有关。此外,政府在疟疾方面的支出，政府和捐助者在治疗方面的综合支出，和孕产妇受教育程度也与疟疾负担最大的国家之间疟疾结局不平等的变化有关。
结论：这项研究的结果表明，优先考虑卫生系统加强疟疾支出和总体疟疾支出，特别是政府的支出，将有助于减少国家内部疟疾负担的不平等。鉴于目前正在努力控制疟疾的国家的结果存在异质性，以及增加用于控制和消除疟疾的国内和国际资金的挑战，有效瞄准有限的资源对于实现全球根除疟疾目标至关重要。
