我国疟疾由控制走向消除的干预措施分析

Determination of key interventions for the transition from control to elimination of malaria in China

目的提出疟疾由控制走向消除的关键措施,为我国实施消除疟疾工作提供依据。方法收集2004-2010年《全国血吸虫病、疟疾和包虫病防治工作年报》数据,选取疟疾疫情较重的典型流行省份,建立发病率变化与干预措施间的面板数据回归模型。结果 2004-2010年全国87.56%的疟疾发病集中在安徽、云南、海南和河南4省。以Y为间日疟发病率,X1为有疟疾病史者休止期服药人数的自然对数(F=14.53,P<0.01,R2=0.72),X2为重点人群休止期服药人数的自然对数(F=15.90,P<0.01,R2=0.71),X3为镜检培训人数(F=11.53,P<0.01,R2=0.61),分别建立了地区固定效应模型,X1、X2和X3均对Y具有负向影响作用;以Y为恶性疟发病率,X1为镜检培训累计人数(F=11.06,P<0.01,R2=0.87),X2为媒介培训人数的自然对数(F=15.28,P<0.01,R2=0.89),分别建立了地区时间双向固定效应模型,X1和X2均对Y具有负向影响作用。结论有疟疾病史者休止期服药、重点人群休止期服药和镜检培训等是控制间日疟疫情的关键干预措施,镜检培训和媒介培训则对恶性疟发病率下降有重要作用。

Objective To determine the key interventions transferring from the control to elimination of malaria in China so as to provide the basic information for achieving malaria elimination. Methods Based on the data collected from the document entitled of The National Annual Report on Schistosomiasis,Malaria and Echinococcosis,published by the National Institute of Parasitic Diseases of Chinese Center for Disease Control and Prevention,the malaria incidence and intervention data were selected only in the typical endemic provinces during the period of 2004-2010. The correlation between the incidence and interventions in the target provinces was analyzed based on the Panel Data Regression Model,and the key interventions were determined. Results Four provinces namely Anhui,Yunnan,Hainan and Henan were targeted with 87.56% of the national malaria figures from 2004 to 2010. When Y was given as vivax malaria incidence,X1 as the log of the number of historical cases receiving radical treatment in the pre-transmission stage（RTPT）（F=14.53,P〈 0.01,R2= 0.72）,X2 as the log of risk population receiving RTPR（F =15.90,P〈 0.01,R2=0.71）and X3 as the number of technicians trained in microscopy（F = 11.53,P〈 0.01,R2=0.61）,three space-fixed effect models were established respectively,and X1,X2,as well as X3 had negative effects on Y value.When Y was given as falciparum malaria incidence,X1 as the accumulated technicians trained in microscopy（F = 11.06,P〈 0.01,R^2= 0.87）,X^2 as the log of technicians trained in entomology（F = 15.28,P〈 0.01,R^2= 0.89）,two two-way（space and time）fixed effect models were established respectively,and both X1 and X2had negative effects on Y value. Conclusion RTPT among historical patients and at-risk populations as well as microscopy training influences the variation of vivax malaria inci-dence,while the significant interventions of microscopy training and vector control training indicate that the integrated measures with strengthened capacity in diagnosis and vector control are of importance in the control of falciparum malaria transmission.