背景:尽管坦桑尼亚采取并一直在实施有效的干预措施来控制并最终消除疟疾,这种疾病仍然是一个主要的公共卫生问题,该国经历了异构传播。最近的研究报道了在Kagera地区出现了具有青蒿素部分耐药性(ART-R)的寄生虫,在Karagwe和Kyerwa两个地区的患病率很高(>10.0%)。这项研究评估了生活在Kagera地区Kyerwa区出现ART-R高流行地区的无症状个体中疟疾感染的患病率和预测因素/风险,坦桑尼亚西北部。
方法:这是一项基于社区的横断面调查,于2023年7月和8月进行,涉及来自Kyerwa地区五个村庄的6个月以上的个人。人口统计,人体测量学,临床,寄生虫学,使用在OpenDataKit(ODK)软件上运行的电子捕获工具收集居住的房屋类型和社会经济状况(SES)数据。通过单变量和多变量逻辑回归确定疟疾感染的预测因子/风险,结果以粗(cORs)和调整后的赔率比(aORs)表示,95%置信区间(CI)。
结果:总体而言,4454人使用快速诊断测试(RDT)进行了测试,1979年(44.4%)有正面结果。疟疾感染的患病率从14.4%到68.5%不等,在各个村庄之间差异很大(p<0.001)。男性感染的患病率和几率显著高于男性(aOR=1.28,95%CI1.08-1.51,p=0.003),学龄儿童(5-≤10岁(aOR=3.88,95%CI3.07-4.91,p<0.001)和10-≤15岁(aOR=4.06,95%CI3.22-5.13,p<0.001))和未使用蚊帐的个体(aOR=1.22,95%CI1.03-1.46,p=0.024)。SES较低的个体发生疟疾感染的几率也较高(aOR=1.42,95%CI1.17-1.72,p<0.001),住在没有窗户的房子里(aOR=2.08,95%CI1.46-2.96,p<0.001),部分打开(aOR=1.33,95%CI1.11-1.58,p=0.002)或完全打开窗口(aOR=1.30,95CI1.05-1.61,p=0.015)。
结论:这五个村庄在微观地理水平上有很高的疟疾感染率和异质性。疟疾感染几率较高的群体包括学童,男性,和SES较低的个人,住在建造简陋的房屋或无床网使用者中。这些是来自ART-R寄生虫高流行地区的重要基线数据,将有助于为这些群体规划干预措施。在未来的研究中监测这种寄生虫的趋势和潜在传播,以及设计对ART-R的回应
BACKGROUND: Although Tanzania adopted and has been implementing effective interventions to control and eventually eliminate malaria, the disease is still a leading public health problem, and the country experiences heterogeneous transmission. Recent studies reported the emergence of parasites with artemisinin partial resistance (ART-R) in Kagera region with high prevalence (> 10.0%) in two districts of Karagwe and Kyerwa. This study assessed the prevalence and predictors/risk of malaria infections among asymptomatic individuals living in a hyperendemic area where ART-R has emerged in Kyerwa District of Kagera region, north-western Tanzania.
METHODS: This was a community-based cross-sectional survey which was conducted in July and August 2023 and involved individuals aged ≥ 6 months from five villages in Kyerwa district. Demographic, anthropometric, clinical, parasitological, type of house inhabited and socio-economic status (SES) data were collected using electronic capture tools run on Open Data Kit (ODK) software. Predictors/risks of malaria infections were determined by univariate and multivariate logistic regression, and the results were presented as crude (cORs) and adjusted odds ratios (aORs), with 95% confidence intervals (CIs).
RESULTS: Overall, 4454 individuals were tested using rapid diagnostic tests (RDTs), and 1979 (44.4%) had positive results. The prevalence of malaria infections ranged from 14.4% to 68.5% and varied significantly among the villages (p < 0.001). The prevalence and odds of infections were significantly higher in males (aOR = 1.28, 95% CI 1.08 -1.51, p = 0.003), school children (aged 5-≤10 years (aOR = 3.88, 95% CI 3.07-4.91, p < 0.001) and 10-≤15 years (aOR = 4.06, 95% CI 3.22-5.13, p < 0.001)) and among individuals who were not using bed nets (aOR = 1.22, 95% CI 1.03-1.46, p = 0.024). The odds of malaria infections were also higher in individuals with lower SES (aOR = 1.42, 95% CI 1.17-1.72, p < 0.001), and living in houses without windows (aOR = 2.08, 95% CI 1.46-2.96, p < 0.001), partially open (aOR = 1.33, 95% CI 1.11-1.58, p = 0.002) or fully open windows (aOR = 1.30, 95%CI 1.05-1.61, p = 0.015).
CONCLUSIONS: The five villages had a high prevalence of malaria infections and heterogeneity at micro-geographic levels. Groups with higher odds of malaria infections included school children, males, and individuals with low SES, living in poorly constructed houses or non-bed net users. These are important baseline data from an area with high prevalence of parasites with ART-R and will be useful in planning interventions for these groups, and in future studies to monitor the trends and potential spread of such parasites, and in designing a response to ART-R.