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To investigate changes in malaria prevalence in Papua New Guinea after the distribution of long-lasting Insecticide-treated nets, starting in , and the introduction of artemisinin-based combination therapy in Two malaria surveys were conducted in — and — They included 77 and 92 randomly selected villages, respectively. In each village, all members of 30 randomly selected households gave blood samples and were assessed for malaria infection by light microscopy. In addition, data were obtained from a malaria survey performed in —SEE VIDEO BY TOPIC: THIRD WHEELING 12 YEAR OLD RELATIONSHIP! w/ Gavin and Coco
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Insecticide-treated nets and malaria prevalence, Papua New Guinea, 2008–2014
To investigate changes in malaria prevalence in Papua New Guinea after the distribution of long-lasting Insecticide-treated nets, starting in , and the introduction of artemisinin-based combination therapy in Two malaria surveys were conducted in — and — They included 77 and 92 randomly selected villages, respectively. In each village, all members of 30 randomly selected households gave blood samples and were assessed for malaria infection by light microscopy. In addition, data were obtained from a malaria survey performed in — Prevalence decreased with altitude.
Plasmodium falciparum was more common than P. Malaria infections were clustered in households. In contrast to findings in —, no significant association between net use and prevalence was found in the later two surveys. The prevalence of both fever and splenomegaly also decreased but their association with malaria infection became stronger.
Large-scale insecticide-treated net distribution was associated with an unprecedented decline in malaria prevalence throughout Papua New Guinea, including epidemic-prone highland areas. The decline was accompanied by broader health benefits, such as decreased morbidity.
Better clinical management of nonmalarial fever and research into residual malaria transmission are required. Se llevaron a cabo dos encuestas sobre la malaria en — y — Las infecciones de malaria se agruparon en los hogares.
National campaigns were organized to distribute free, long-lasting insecticide-treated nets at the household level and, since late , malaria rapid diagnostics tests, improved diagnostic microscopy and artemisinin-based combination therapy have increasingly been provided at public and church-run health-care facilities. In —, towards the end of the first insecticide-treated net campaign, the Papua New Guinean Institute of Medical Research conducted a country-wide malaria indicator survey.
A few P. Subsequent national malaria surveys conducted by the Papua New Guinean Institute of Medical Research in — and — to evaluate the national malaria control programme provided evidence that coverage with long-lasting insecticide-treated nets had increased. National malaria surveys were conducted from November to August and from November to August The pre province structure was adopted to ensure comparability over time: Hela Province was considered part of Southern Highlands Province and Jiwaka Province, part of Western Highlands Province.
For each village, the survey team leader selected a random sample of 30 households using a list compiled by village leaders. All members of sampled households were eligible for inclusion. The first survey in —, whose results are presented for comparison, included villages from only districts covered by the long-lasting insecticide-treated net campaign, but the method of selecting households and their members was identical to that in subsequent surveys.
Data were collected using an adapted Malaria Indicator Survey questionnaire. Trained study nurses prepared one thick and one thin blood film for light microscopy. Symptomatic household members were offered a malaria rapid diagnostic test and treatment or referral to the nearest health-care facility, where appropriate. Malaria was diagnosed by light microscopy at the Papua New Guinean Institute of Medical Research following established procedures.
Slides with discordant results were examined by a third microscopist, who was certified at World Health Organization WHO level 1 or 2. A slide was considered positive for malaria if judged positive by at least two microscopists.
For the — survey, additional assessments of unclear species identifications were performed at the Australian Army Malaria Institute in Australia by WHO-certified level-1 malaria microscopists. The number of parasites per white blood cells was determined.
To account for stratified sampling, national estimates were weighted, as described elsewhere. Hackett grade 1 to 5 and anaemia was defined according to WHO recommendations, which include age-specific cut-offs and altitude corrections. Of the 77 villages included, 58 In the — survey, blood samples were collected from individuals.
Of the 92 villages included, 66 The small number of villages at intermediate altitudes reflects the population distribution in Papua New Guinea. The prevalence of P. There was no evidence of P. CI: confidence interval; P. Between the — and — surveys, an increase in the prevalence of P. However, the prevalence of infection by both species decreased in all provinces between — and — Age-standardized prevalence of Plasmodium infection and insecticide-treated net use, by region and survey date, national malaria surveys, Papua New Guinea, — Age-standardized prevalence of Plasmodium infection and insecticide-treated net use in lower-prevalence areas, by province and survey date, national malaria surveys, Papua New Guinea, — Age-standardized prevalence of Plasmodium infection and insecticide-treated net use in higher-prevalence areas, by province and survey date, national malaria surveys, Papua New Guinea, — NA: not applicable; ND: not determined; P.
In the — survey, the prevalence of P. Moreover, no P. Regression analysis findings are presented in Table 5. For P. In —, the difference in the prevalence of P. However, Note: The study age groups, as indicated in the figure, were 0—0. Prevalence of P. Note: The study age groups, as indicated in the figures, were 0—0. Long-lasting insecticide-treated nets were used by Malaria cases were clustered in households.
In all surveys, individuals infected with malaria were significantly more likely than those without to report a recent fever episode, to show symptoms of acute fever i. Although the proportion of the population with a recent history of fever decreased over time Fig. In —, The prevalence of anaemia remained high over time and increased between — and — Fig.
Anaemia was defined according to WHO recommendations, which included age-specific cut-offs and altitude corrections. Severe anaemia was defined according to WHO recommendations, which included age-specific cut-offs and altitude corrections. In three provinces with zero prevalence, rapid diagnostic tests found that people with fever who had not left the province had a current or recent infection. Consequently, maintaining a high level of intervention coverage is crucial for avoiding resurgence.
The notion that climatic change might have increased malaria in the highlands could not be substantiated. Unlike in previous years, 2 , 3 P. The prevalence of fever and splenomegaly declined with that of parasite infection. However, the association between infection and symptoms became stronger over time, perhaps because the proportion of microscopically detectable infections that were symptomatic increased as transmission and immunity declined.
The decrease in splenomegaly was most marked, which may reflect a reduction in chronic malaria infection. Between and , the distribution of insecticide-treated nets to households was the only large-scale malaria intervention in Papua New Guinea.
The lack of an association between net use and malaria prevalence in the last two surveys may have been due to factors such as outdoor biting, which sustained disease transmission, and the mass effect of net use on all community members. Combination therapy was introduced in November and, by late , was available at approximately half of health-care facilities. The community benefits of combination therapy can be maximized by prompt diagnosis and treatment. Better guidance on differential diagnosis and on fever management is warranted.
We found that individuals cohabiting with another infected person were more likely to carry parasites, possibly due to similar exposure patterns. Earlier studies in Papua New Guinea found conflicting evidence of the impact of housing, namely raised structures, on mosquito exposure. In our study, we used age-standardization to account for differences in the age-composition of participants between surveys and between participants who gave blood samples and the general population.
However, as the — survey included only districts where nets were distributed, the national prevalence of parasite infection may have been underestimated.
Data from sentinel sites showed that the prevalence after net distribution was 4. In conclusion, increased use of long-lasting insecticide-treated nets in Papua New Guinea was associated with a rapid and significant decline in malaria prevalence — the lowest prevalence ever recorded was in — The decline also occurred in the epidemic-prone highlands.
Light microscopy showed that P. Declining prevalence was accompanied by broader health benefits, such as decreased morbidity. However, nonmalarial fever now requires better clinical management.
Research into the drivers of residual malaria transmission and the burden and role of submicroscopic parasite infection are crucial for better targeting of interventions and for eliminating the disease.
We thank all participating individuals, communities and village leaders, government officials in the provinces and at the National Department of Health, all partners in the Malaria Technical Working Group, staff at the Papua New Guinean Institute of Medical Research and the Australian Army Malaria Institute and field data collectors and we remember the five team members who disappeared without trace in West New Britain province.
National Center for Biotechnology Information , U. Bull World Health Organ. Published online Sep 5. Find articles by Manuel W Hetzel. Find articles by Justin Pulford. Find articles by Yangta Ura. Find articles by Sharon Jamea-Maiasa.
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В любой другой реальности было бы куда больше здравого смысла. Я, университетский профессор, - подумал он, - выполняю секретную миссию. Бармен с любезной улыбкой протянул Беккеру стакан: - A su gusto, senor.
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Сегодняшний день стал для него днем сплошных фиаско. То, что началось как в высшей степени патриотическая миссия, самым неожиданным образом вышло из-под контроля. Коммандер был вынужден принимать невероятные решения, совершать чудовищные поступки, на которые, как ему казалось раньше, не был способен.
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