云南省边境疟疾流行区农村居民疟疾健康教育干预效果评价

目的了解云南省边境疟区项目干预地区农村居民掌握疟疾相关知识、态度和行为情况,为后续项目的疟疾健康教育干预的实施提供依据。方法在云南省疟区32个县,采用多阶段抽样方法进行横断面调查。自制调查问卷,比较项目干预区目标人群和对照区人群中疟疾相关知识、态度和行为的情况。结果项目干预组受访者中知道疟疾症状、传播途径和预防知识的比例为72.58%、30.45%和24.00%,均大于对照组的54.02%、13.30%和10.17%（P均〈0.01）。项目干预组受访者知道杀虫剂浸泡蚊帐、知道使用杀虫剂浸泡蚊帐目的、知道两次浸泡蚊帐间隔时间和知道杀虫剂浸泡蚊帐不会影响健康的知识均明显好于对照组（P均〈0.01）。项目干预组受访者愿意使用杀虫剂浸泡蚊帐、拥有杀虫剂浸泡蚊帐和调查前夜使用蚊帐的比例为60.48%、15.66%和43.38%,均大于对照组的55.76%、0.45%、39.60%（P均〈0.01）,项目干预组受访者家庭调查前两周内的发热病人及时就诊的比例（38.87%）小于对照组（55.06%,P〈0.01）。结论开展项目干预措施后,项目地区目标人群的疟疾相关知识、态度和行为有明显的改善,但是知识、态度和行为的改善程度并不一致,对重点干预措施如杀虫剂浸泡蚊帐和发热病人及时就诊的知识、态度和行为的改变还有不足。     

云南省疟区杀虫剂浸泡蚊帐使用状况及其推广对策

目的了解云南省疟区杀虫剂浸泡蚊帐的现状及相关影响因素,为推广杀虫剂浸泡蚊帐的实施提供对策。方法在云南省疟区47个县,采用多阶段抽样方法进行横断面调查。结果在被调查家庭中,8．68％的家庭拥有杀虫剂浸泡蚊帐。Logistic回归分析显示,家庭经济水平、性别、婚姻状况、教育水平、使用杀虫剂浸泡蚊帐态度、疟疾传播知识、疟疾预防知识等因素影响蚊帐的使用。结论在推广杀虫剂浸泡蚊帐中,应关注贫困家庭、女性、单身及文盲人群,并通过传递疟疾传播途径、预防等核心知识来促进杀虫剂浸泡蚊帐的使用。     

边远贫困山区少数民族疟疾诊治干预效果分析

目的 探讨改进边远贫困山区少数民族疟疾诊断和治疗可及性策略.方法 免费提供疟疾诊断和治疗;培训当地本民族的村疟防员制作发热病人血片,为疟疾病人送药并监督服药,开展以入户为主的面对面健康教育.结果 村卫生人员与居民比从干预前的1:1 116.75改变为干预后的1:248.17;发热开始24 h内求医病人比例,使用公共卫生机构发热病人比例和对疟防服务满意村民比例分别从基线的23.03%(95%CI=18.81～27.71).56.94%(95%CI=52.55～61.25)和82.65%(95%CI=81.23～86.31)提高到干预后评估调查的86.95%(95%CI=68.47～96.57),91.30%(95%CI=74.13-98.51)和96.81%(95%CI=93.08～98.82).结论 改进当地经济、地理、信息和文化方面疟疾诊治可及性,与其他措施一起有效地降低了当地疟疾的发病和流行程度.     

云南省边境疟疾流行区居民疟疾防治IEC策略制订的需求分析

[目的]了解云南省边境疟疾流行区居民对疟防知识的认知情况、当地疟疾防治的现况,为云南省全球基金第五轮疟疾项目制订IEC策略提供依据. [方法]采用定量与定性相结合的方法对陇川、腾冲、孟连的9个乡镇的2 666户农村居民进行了问卷调查,分别对村干部等重点居民和村医、州、县、乡疟疾防治专业人员进行了小组访谈,并运用χ2检分析结果. [结果]被调查者中72.58%知道疟疾,24.42%道如何预防疟疾.受访者中拥有杀虫剂浸泡蚊帐的家庭仅10.32%.愿意使用杀虫剂浸泡蚊帐的受访者为67.22%.调查前夜使用蚊帐的受访者为37.81%.受访者家庭中发热病人的就诊率为70.32%.不同性别、民族和教育年限的人群知道疟疾传播途径和疟疾预防方法的情况存在统计学差异. [结论]本次需求调查为制定云南省全球基金第五轮疟疾项目流行区居民疟疾防治IEC策略提供了依据.     

黔桂灭疟联防区疟疾防治措施及其效果评价

目的 了解联防区疟疾流行状况和发展态势,为防治工作提供依据.方法 对发热病人、流动人口和疫区重点人群进行采血镜检,治疗随访疟疾病人,在病灶点使用菊酯类杀虫剂喷洒或浸帐灭蚊.结果 2004年联防区发现疟疾病例共424例,较2003年下降了21.98%.但有5个县(市)疟疾发病率回升,幅度为21.05%～481.82%.当地病例占多数,问日疟为优势虫种,病例呈高度分散存在.结论 抗疟措施适合实际,效果明显,多数县(市)疟情稳定,个别县(市)疫情有波动.     

疟疾患者求医行为的影响因素研究

目的　探讨影响疟疾病人求医行为主要因素。方法　对湖南、贵州两省的５ 个县的２１２ 名在１９９６年５～１０月间新发疟疾病人进行了回顾性调查，并进行单因素与多因素分析。结果　患者就医的时间间隔为５７５天，在各类就医地点中以村卫生室频率最高（４０５７％ ），病人遵守医嘱的比例较高（７８３０％ ）。在单因素分析的基础上对患者求医去向的影响因素进行了非条件ＬＯＧＩＳＴＩＣ回归分析，筛选出的主要因素作用大小依次是去第一家医疗机构就诊的原因、去医院就医所用的时间、出现症状后病人自己及家人是否怀疑患了疟疾、发病前的疟防知识。结论　疟疾病人行为受家庭、疟防知识和医疗机构的医疗服务等因素的影响。     

四川省青神县疟疾基线调查报告

目的了解青神县消除疟疾行动计划启动初疟疾流行情况、防治工作基础和能力状况,为达到消除疟疾目标提供基线数据。方法按四川省消除疟疾行动计划实施方案中基线调查方法开展疟疾流行情况、传疟媒介、防治工作和能力现状等调查。结果 2006年后无疟疾本地感染病例,人群疟疾抗体水平滴度均〈1：20,传疟媒介为中华按蚊,密度为4只/夜;居民、中小学生疟疾防治知识知晓率分别为53%、64%;县、乡、村临床医生接受疟疾知识培训比例分别为10%、52%、14%;县、乡接受疟原虫镜检培训比例分别为39%、27%。结论今后消除疟疾工作应加强临床医生和镜检人员知识培训与居民、学生、外出疟区务工人员疟防知识宣传。     

嘉兴市低疟区疟疾流行病学特点与监测方法探讨

目的分析低疟区疟疾流行特点,探讨低疟区疟疾监测方法。方法对嘉兴市基本消灭疟疾后的疟疾监测结果做发热病人血检情况,疟疾病例分类、地区分布、性别与年龄分布、发病时间分布,发病率与感染来源,疫点周围人群调查及病例治疗后复查血检情况,媒介按蚊等回顾性调查研究。结果嘉兴市15年累计发热病人血检阳性率24.25/万(302/124529),均为间日疟。其中:初诊为疟疾和疑似疟疾(简称二热病人)者血检阳性率60.29%(290/481),占总阳性数96.03%(290/302);感冒和发热原因不明者血检阳性率仅为0.97/万(12/124048),占总阳性数3.97%(12/302)。病人发病分布散在,本市户籍人口占25.50%(77/302),年均发病率0.23/10万,外来流动人口占74.50%(225/302)。以高疟区青壮年打工者为主要发病者;以5~10月份为发病高峰期;以中华按蚊为惟一媒介;无二代病例发生。结论嘉兴市疟疾发病率低,疫情稳定。以输入性病例为主的呈点状分布的流行特点。因此,疟疾监测在流动人口较多的低疟区,且以中华按蚊为惟一媒介,对当地人群可以采用二热病人、对流动人口采用四热病人的监测方案。     

淮安市2007—2011年疟疾疫情分析

目的分析淮安市疟疾流行现状,为制定防治措施提供依据。方法对淮安市2007—2011年疟疾血检年报、网络直报、个案调查及"三热"病人资料进行统计分析。结果淮安市2007—2011年共发生309例疟疾病例,其中间日疟215例,恶性疟93例,卵形疟1例,年发病率为0.67/10万。2007—2011年流动人口疟疾发病按年份所占比例依次为19.01%、27.59%、30.91%、70.9%和93.33%,呈逐年上升趋势。实验室血检发热病人263 925人,本地血检阳性率0.01%;外来人口阳性率0.97%,两者差异有统计学意义(χ2=71.03,P<0.01)。结论开展对"三热"病人的监测是控制疟疾传播与流行的主要措施,流动人口是淮安市疟疾防治工作的重点。     

豫北地区疟疾防治达标考核评价

1985～1989年间,省卫生厅基本消灭疟疾县(市)考核小组,对豫北43县(市、区)分6批进行了疟疾防治效果的达标考核结果,43县(市、区)的疟疾发病率已连续三年以上稳定在5%以下,无超过5%的乡:发热病人血检率达5％以上,血检村覆盖率达90％以上;各级疟防领导组织基层防疫网健全,疟防监测系统基本建立,专业技术人员能够较好的落实防治措施证明,豫北地区的疟疾防治效果已达到卫生部颁布的基本消灭疟疾标准。     

Self-treatment of malaria in a rural area of western Kenya.

Reported are the results of a study of residents'' knowledge about malaria and antimalarial drugs and of their treatment-seeking behaviour in a rural area of western Kenya. The study subjects were generally well-informed about the symptoms of the disease. Malaria was perceived as a relatively mild illness, much less severe than acquired immunodeficiency syndrome (AIDS), measles, difficulty in breathing, and diarrhoea. Self-treatment was extremely common: of 138 episodes of febrile illness, 60% were treated at home with herbal remedies or medicines purchased at local shops, and only 18% received treatment at a health centre or hospital; no treatment was sought by the remainder. Commercially available chloroquine preparations were perceived as more effective than either antipyretics or herbal remedies for the treatment of malaria, and injections were regarded as more effective than oral medications. 4-Amino-quinolines were used to treat 58% of febrile illnesses but in only 12% of the cases was a curative dose of > or = 25 mg/kg body weight employed. Even attendance at a health centre did not ensure adequate treatment because of the common practice of sharing medication among family members. Greatly increased attention should be paid to the role of home treatment of malaria when policies are being developed for the management of febrile illnesses in sub-Saharan Africa.     

Looking within the household: gender roles and responses to malaria in Ghana

Studies of factors affecting treatment-seeking behaviour for malaria have rarely considered the influence of gender roles and relations within the household. This study supported district-level government workers in the Volta Region of Ghana in conducting a situational analysis of gender inequities in relation to the malaria burden and access to healthcare services for malaria in one community in their district. Qualitative and participatory methods, such as focus group discussions, in-depth individual interviews and ranking exercises, were used. The study found that women who lacked either short- or long-term economic support from male relatives, or disagreed with their husbands or family elders about appropriate treatment-seeking, faced difficulties in accessing health care for children with malaria. This illustrates the significant influence of women's access to resources and decision-making power on treatment-seeking behaviour for children with febrile illnesses, and the importance of approaching malaria management in the community or household from a gender perspective.     

Local transmission of Plasmodium vivax malaria--Palm Beach County, Florida, 2003

The majority of malaria cases diagnosed in the United States are imported, usually by persons who travel to countries where malaria is endemic. However, small outbreaks of locally acquired mosquito-transmitted malaria continue to occur. Despite certification of malaria eradication in the United States in 1970, 11 outbreaks involving 20 cases of probable locally acquired mosquito-transmitted malaria have been reported to CDC since 1992, including two reported in July 1996 from Palm Beach County, Florida (Palm Beach County Health Department, unpublished data, 1998). This report describes the investigation of seven cases of locally acquired Plasmodium vivax malaria that occurred in Palm Beach County during July-August 2003. In addition to considering malaria in the differential diagnosis for febrile patients with a history of travel to malarious areas, health-care providers also should consider malaria as a possible cause of fever among patients who have not traveled but are experiencing alternating fevers, rigors, and sweats with no obvious cause.     

Fever episodes in a holoendemic malaria area of Tanzania: parasitological and clinical findings and diagnostic aspects related to malaria.

All episodes of acute illness, in children aged 0-9 years, were registered during 3 years in a health clinic in a village of about 500 inhabitants in a malaria holoendemic area on the Tanzanian coast. Of 668 clinical episodes, 395 were diagnosed as malaria. There was no death. Only 5% of the children with malaria episodes came to the clinic after more than 3 d of symptoms. All 11 severe anaemias occurred among these children. Fever was reported in 98%, vomiting in 15%, and diarrhoea in 8% of the malaria episodes. Intermittent fever was reported in 98% of the malaria patients with more than one day of fever, compared to 4% of those with other febrile illnesses. Parasite densities > or = 10,000/microliters were found in 48% of the malaria episodes. Densities > or = 400/microliters were found in 96% of the malaria episodes and in only 8% of the other febrile illnesses. The 16 malaria episodes (4%) with densities below that level were all in children under one year of age. The ability of the rural medical aid or the doctor to differentiate malaria episodes from other febrile illnesses without microscopical examination was limited. Although very few malaria episodes were missed, substantial over-diagnosis resulted in specificity values of only 13% and 52% for their respective malaria diagnoses. It is concluded that intermittent fever was strongly associated with malaria, but a high accuracy of malaria diagnosis in febrile children requires microscopical examination.(ABSTRACT TRUNCATED AT 250 WORDS)     

Transition in the Cause of Fever from Malaria to Dengue,Northwestern Ecuador, 1990–2011

In tropical areas, the predominant cause of fever has historically been malaria. However by 2011, among febrile patients in northwestern Ecuador, dengue was identified in 42% and malaria in none. This finding suggests a transition in the cause of fever from malaria to other illnesses, such as dengue.     

Prevalence and predictors of urinary tract infection and severe malaria among febrile children attending Makongoro health centre in Mwanza city,North-Western Tanzania

Background

In malaria endemic areas, fever has been used as an entry point for presumptive treatment of malaria. At present, the decrease in malaria transmission in Africa implies an increase in febrile illnesses related to other causes among underfives. Moreover, it is estimated that more than half of the children presenting with fever to public clinics in Africa do not have a malaria infection. Thus, for a better management of all febrile illnesses among under-fives, it becomes relevant to understand the underlying aetiology of the illness. The present study was conducted to determine the relative prevalence and predictors of P. falciparum malaria, urinary tract infections and bacteremia among under-fives presenting with a febrile illness at the Makongoro Primary Health Centre, North-Western Tanzania.

Methods

From February to June 2011, a cross-sectional analytical survey was conducted among febrile children less than five years of age. Demographic and clinical data were collected using a standardized pre-tested questionnaire. Blood and urine culture was done, followed by the identification of isolates using in-house biochemical methods. Susceptibility patterns to commonly used antibiotics were investigated using the disc diffusion method. Giemsa stained thin and thick blood smears were examined for any malaria parasites stages.

Results

A total of 231 febrile under-fives were enrolled in the study. Of all the children, 20.3% (47/231, 95%CI, 15.10-25.48), 9.5% (22/231, 95%CI, 5.72-13.28) and 7.4% (17/231, 95%CI, 4.00-10.8) had urinary tract infections, P. falciparum malaria and bacteremia respectively. In general, 11.5% (10/87, 95%CI, 8.10-14.90) of the children had two infections and only one child had all three infections. Predictors of urinary tract infections (UTI) were dysuria (OR = 12.51, 95% CI, 4.28-36.57, P < 0.001) and body temperature (40-41 C) (OR = 12.54, 95% CI, 4.28-36.73, P < 0.001). Predictors of P. falciparum severe malaria were pallor (OR = 4.66 95%CI, 1.21-17.8, P = 0.025) and convulsion (OR = 102, 95% CI, 10-996, P = 0.001). Escherichia coli were the common gram negative isolates from urine (72.3%, 95% CI, 66.50-78.10) and blood (40%, 95%CI, and 33.70-46.30). Escherichia coli from urine were 100% resistant to ampicillin, 97% resistant to co-trimoxazole, 85% resistant to augmentin and 32.4% resistant to gentamicin; and they were 100%, 91.2% and 73.5% sensitive to meropenem, ciprofloxacin and ceftriaxone respectively.

Conclusion

Urinary tract infection caused by multi drug resistant Escherichia coli was the common cause of febrile illness in our setting. Improvement of malaria diagnosis and its differential diagnosis from other causes of febrile illnesses may provide effective management of febrile illnesses among children in Tanzania     

中缅边境地区疟疾防控效果分析

目的 分析中缅边境地区疟疾防控成效,为今后边境地区疟疾消除工作提供参考。方法 选择云南省中缅边境12个县市,收集2007-2013 年疟疾防控相关资料以及疫情相关数据,评价边境地区疟疾控制消除工作成效。结果 2007-2013年云南省中缅边境12个县中,血检发热病人915 270人次,治疗现症患者13 146例,休止期根治121 894人,预防服药292 720人,室内杀虫剂喷洒和药物浸泡蚊帐保护人数分别为1 408 573人、1 114 360人。疟疾发病率由2007年的11.35/10 000降至2013年的0.88/10 000,下降了92.24%,疟疾病例数由2007年6 108例减少到2013年290例,减少了95.25%;其中本地感染病例3 546例减少到32例,减少了99.10%。输入性疟疾病例占总病例的比例由2007年的41.95%上升至2013年的88.97%,主要来源地为缅甸。结论 中缅边境地区疟疾疫情有好转,应重点关注输入性疟疾的传播风险,进一步完善边境地区疟疾联防联控机制,确保消除疟疾,并巩固消除成果。