美国哈佛大学Jessica Cohen团队，研究了撒哈拉以南非洲国家的疟疾快速检测与发热性疾病管理和儿童死亡率的相关性。相关论文发表在2024年9月18日出版的《美国医学会杂志》上。

在撒哈拉以南非洲国家，迅速诊断疟疾对于管理患有发热性疾病的儿童至关重要，疟疾仍然是5岁以下儿童死亡的主要原因。疟疾护理点快速诊断测试（RDTs）的开发和推广改变了实践，但关于疟疾RDTs如何影响撒哈拉以南非洲国家5岁以下儿童发热性疾病和死亡率的系统证据有限。

为了评估撒哈拉以南非洲国家5岁以下儿童疟疾RDT的分布与发热性疾病和死亡率管理之间的相关性，研究组进行了一项准实验性研究，使用一个新的数据集，将疟疾RDT分布与35个撒哈拉以南非洲国家的165个具有全国代表性的家庭调查联系起来，并提供了死亡率数据。该样本包括2000年至2019年间约390万儿童年的观察结果和约26万5岁以下儿童的发热性疾病发作。固定效应线性概率模型用于分析每名5岁以下儿童（每年按国家）分布的疟疾RDT变化与血液检测、抗疟疾药物使用、抗生素使用、对症治疗使用和死亡率之间的关联。在疟疾流行率不同的撒哈拉以南非洲国家，也评估了检测和治疗效果的差异。

死亡样本包括1317866名儿童，发热样本包括256292名儿童。发热性疾病患儿的平均年龄为2.4岁（SD，1.3岁），49%为女孩。每增加一个5岁以下儿童的疟疾RDT，血液检测就会增加3.5个百分点（95%CI，3.2-3.8个百分点），抗疟疾药物的使用会增加1.5个百分点（95%CI，1.2-1.8个百分点）、抗生素使用会增加0.4个百分点（95%CI，0.1-0.6个百分点），对症治疗会减少0.4个百分点。每增加一个5岁以下儿童的疟疾RDT，儿童死亡率就会降低0.34/1000儿童年（95%CI，每1000儿童年0.15-0.52死亡）。疟疾RDT分布对药物使用和儿童死亡率的影响因疟疾流行情况而异（低与高）；只有在疟疾高发地区，生存率才有所提高。

研究结果表明，在撒哈拉以南非洲国家，疟疾RDT分布的增加与血液检测的增加、抗疟疾药物的使用增加以及5岁以下儿童生存率的适度提高有关。然而，疟疾RDT与已经很高的抗生素使用率的增加有关，这表明需要更全面的发热性疾病病例管理方法。

附：英文原文

Title: Malaria Rapid Tests, Febrile Illness Management, and Child Mortality Across Sub-Saharan African Countries

Author: Han Zhang, Günther Fink, Jessica Cohen

Issue&Volume: 2024-09-18

Abstract:

Importance  A prompt malaria diagnosis is crucial for the management of children with febrile illness in sub-Saharan African countries, where malaria remains a leading cause of mortality among children younger than 5 years of age. The development and distribution of point-of-care rapid diagnostic tests (RDTs) for malaria has transformed practice, but limited systematic evidence exists on how malaria RDTs have affected the management of febrile illness and mortality for children younger than 5 years of age across sub-Saharan Africa countries.

Objective  To evaluate the association between the distribution of malaria RDTs and the management of febrile illness and mortality among children younger than 5 years of age in sub-Saharan African countries.

Design, Setting, and Participants  This quasi-experimental study used a novel dataset linking malaria RDT distribution to 165 nationally representative household surveys across 35 sub-Saharan African countries with mortality data. The sample comprised approximately 3.9 million child-year observations and approximately 260000 febrile illness episodes in children younger than 5 years of age between 2000 and 2019.

Main Outcomes and Measures  Fixed-effects linear probability models were used to analyze the association between variation in malaria RDTs distributed per child younger than 5 years of age (by country per year) and blood testing, antimalarial drug use, antibiotic use, use of symptomatic treatments, and mortality rates. Variation in the effects of testing and treatment was also assessed across the sub-Saharan African countries that had varying prevalence of malaria.

Results  The mortality sample included 1317866 children and the fever sample included 256292 children. The mean age of the children with febrile illness was 2.4 years (SD, 1.3 years) and 49% were female. Each additional malaria RDT distributed per child younger than 5 years of age was associated with an increase of 3.5 percentage points (95% CI, 3.2-3.8 percentage points) in blood testing, an increase of 1.5 percentage points (95% CI, 1.2-1.8 percentage points) in the use of antimalarial drugs, an increase of 0.4 percentage points (95% CI, 0.1-0.6 percentage points) in antibiotic use, and a decrease of 0.4 percentage points (95% CI, 0.1-0.8 percentage points) in the use of treatments for symptoms. Each additional malaria RDT distributed per child younger than 5 years of age was associated with a reduction in child mortality of 0.34 deaths per 1000 child-years (95% CI, 0.15-0.52 deaths per 1000 child-years). The effects of malaria RDT distribution on medication use and child mortality varied across prevalence settings (low vs high) for malaria; there were survival improvements only in areas that had a high prevalence of malaria.

Conclusions and Relevance  Increasing distribution of malaria RDTs was associated with increased blood testing, increased use of antimalarial drugs, and modestly improved survival in children younger than 5 years of age in sub-Saharan African countries. However, malaria RDTs were associated with increases in the rates of antibiotic use that were already high, suggesting that more comprehensive approaches to case management of febrile illness are needed.

DOI: 10.1001/jama.2024.12589

Source: https://jamanetwork.com/journals/jama/fullarticle/2823809