背景:尽管越南在控制疟疾方面取得了成功,这种疾病仍然是一个重大的健康问题,特别是在越南中部。这项研究旨在评估环境之间的相关性,气候,以及该地区疟疾病例的社会经济因素。
方法:该研究于2018年1月至2022年12月在越南中部15个省进行。每月疟疾病例来自疟疾研究所,寄生虫学,昆虫学QuyNhon,越南。Environmental,气候,使用GoogleEarthEngine脚本检索社会经济数据。使用具有条件自回归先验结构的空间和时空随机效应的贝叶斯框架进行多变量零膨胀泊松回归。后验随机效应是使用带有吉布斯抽样的贝叶斯马尔可夫链蒙特卡罗模拟来估计的。
结果:研究期间共有5,985例恶性疟原虫和2,623例间日疟原虫。恶性疟原虫风险增加五倍(95%可信区间[CrI]4.37,6.74),每增加1个单位的归一化差异植被指数(NDVI)无滞后和8%(95%CrI7%,9%)在6个月滞后时,最高温度(TMAX)每增加1ºC。虽然风险降低1%(95%CrI0%,1%)的降水量增加了1毫米,滞后6个月。1个月后NDVI增加1个单位与间日疟原虫风险增加4倍(95%CrI2.95,4.90)相关。此外,风险增加6%(95%CrI5%,7%)和3%(95%CrI1%,5%)白天地表温度每增加1ºC,滞后6个月,滞后4个月,TMAX,分别。空间分析表明,在越南中部高地和中部东南部,这两种物种的平均疟疾风险较高,而在北部和西北部地区的风险较低。
结论:环境,气候,社会经济风险因素和空间疟疾集群对于设计适应性战略至关重要,以最大限度地发挥有限的公共卫生资源对消除越南疟疾的影响。
BACKGROUND: Despite the successful efforts in controlling malaria in Vietnam, the disease remains a significant health concern, particularly in Central Vietnam. This study aimed to assess correlations between environmental, climatic, and socio-economic factors in the district with malaria cases.
METHODS: The study was conducted in 15 provinces in Central Vietnam from January 2018 to December 2022. Monthly malaria cases were obtained from the Institute of Malariology, Parasitology, and Entomology Quy Nhon, Vietnam. Environmental, climatic, and socio-economic data were retrieved using a Google Earth Engine script. A multivariable Zero-inflated Poisson regression was undertaken using a Bayesian framework with spatial and spatiotemporal random effects with a conditional autoregressive prior structure. The posterior random effects were estimated using Bayesian Markov Chain Monte Carlo simulation with Gibbs sampling.
RESULTS: There was a total of 5,985 Plasmodium falciparum and 2,623 Plasmodium vivax cases during the study period. Plasmodium falciparum risk increased by five times (95% credible interval [CrI] 4.37, 6.74) for each 1-unit increase of normalized difference vegetation index (NDVI) without lag and by 8% (95% CrI 7%, 9%) for every 1ºC increase in maximum temperature (TMAX) at a 6-month lag. While a decrease in risk of 1% (95% CrI 0%, 1%) for a 1 mm increase in precipitation with a 6-month lag was observed. A 1-unit increase in NDVI at a 1-month lag was associated with a four-fold increase (95% CrI 2.95, 4.90) in risk of P. vivax. In addition, the risk increased by 6% (95% CrI 5%, 7%) and 3% (95% CrI 1%, 5%) for each 1ºC increase in land surface temperature during daytime with a 6-month lag and TMAX at a 4-month lag, respectively. Spatial analysis showed a higher mean malaria risk of both species in the Central Highlands and southeast parts of Central Vietnam and a lower risk in the northern and north-western areas.
CONCLUSIONS: Identification of environmental, climatic, and socio-economic risk factors and spatial malaria clusters are crucial for designing adaptive strategies to maximize the impact of limited public health resources toward eliminating malaria in Vietnam.