背景:几十年来,赞比亚已经实施了室内残留喷洒(IRS)来预防疟疾,但其有效性尚未在Vubwi区进行长期评估。这项研究旨在评估赞比亚和Vubwi地区的IRS与疟疾负担之间的关系,并探讨与拒绝IRS相关的因素。
方法:采用一项回顾性研究,通过Spearman相关性分析,分析了2001-2020年赞比亚和2014-2020年Vubwi区IRS与疟疾发病率之间的关联。病例对照研究用于探讨2021年Vubwi区家庭拒绝IRS的相关因素。进行逻辑回归模型以确定与IRS拒绝相关的因素。
结果:疟疾发病率在2001年达到峰值(391/1000),在2019年降至最低(154/1000)。2001-2003年、2003-2008年、2008-2014年、2014-2018年和2018-2020年的年度百分比变化为-6.54%,-13.24%,5.04%,-10.28%和18.61%,分别。2005-2020年(r=-0.685,P=0.003)和2005-2019年(r=-0.818,P<0.001)观察到赞比亚受IRS保护的人口占总人口的百分比(覆盖率)与整个人口的平均疟疾发病率之间呈显着负相关。在264名参与者中(拒绝组59名,接受者组205名),具有特定职业的参与者(自雇人士:OR0.089,95%CI0.022-0.364;淘金:OR0.113,95%CI0.022-0.574;家庭主妇:OR0.129,95%CI0.026-0.628,农民:与雇员相比,OR0.135,95%CI0.030-0.608),家庭成员中没有疟疾病例(OR0.167;95%CI0.071-0.394),实施IRS而那些具有中等教育水平(OR3.690,95%CI1.245-10.989)的人与从未上过学的人相比,拒绝实施IRS的风险更高。
结论:增加IRS的覆盖率与赞比亚疟疾发病率的下降有关。尽管在Vubwi区没有观察到这种情况,可能是因为伏布威区的特殊地理位置。应全面实施人际沟通和有针对性的健康教育,以确保家庭意识并获得社区信任。
BACKGROUND: Indoor residual spraying (IRS) has been implemented to prevent malaria in Zambia for several decades, but its effectiveness has not been evaluated long term and in Vubwi District yet. This study aimed to assess the association between IRS and the malaria burden in Zambia and Vubwi District and to explore the factors associated with refusing IRS.
METHODS: A retrospective study was used to analyze the association between IRS and malaria incidence in Zambia in 2001-2020 and in Vubwi District in 2014-2020 by Spearman correlation analysis. A case-control study was used to explore the factors associated with IRS refusals by households in Vubwi District in 2021. A logistic regression model was performed to identify factors associated with IRS refusals.
RESULTS: The malaria incidence reached its peak (391/1000) in 2001 and dropped to the lowest (154/1000) in 2019. The annual percentage change in 2001-2003, 2003-2008, 2008-2014, 2014-2018 and 2018-2020 was - 6.54%, - 13.24%, 5.04%, - 10.28% and 18.61%, respectively. A significantly negative correlation between the percentage of population protected by the IRS against the total population in Zambia (coverage) and the average malaria incidence in the whole population was observed in 2005-2020 (r = - 0.685, P = 0.003) and 2005-2019 (r = - 0.818, P < 0.001). Among 264 participants (59 in the refuser group and 205 in the acceptor group), participants with specific occupations (self-employed: OR 0.089, 95% CI 0.022-0.364; gold panning: OR 0.113, 95% CI 0.022-0.574; housewives: OR 0.129, 95% CI 0.026-0.628 and farmers: OR 0.135, 95% CI 0.030-0.608 compared to employees) and no malaria case among household members (OR 0.167; 95% CI 0.071-0.394) had a lower risk of refusing IRS implementation, while those with a secondary education level (OR 3.690, 95% CI 1.245-10.989) had a higher risk of refusing IRS implementation compared to those who had never been to school.
CONCLUSIONS: Increasing coverage with IRS was associated with decreasing incidence of malaria in Zambia, though this was not observed in Vubwi District, possibly because of the special geographical location of Vubwi District. Interpersonal communication and targeted health education should be implemented at full scale to ensure household awareness and gain community trust.