气候变化与疟疾:呼吁进行可靠的分析

David L Smith, Daniel J Laydon, Kaustubh Chakradeo, Mark P Khurana, Jaffer Okiring, David A Duchene, Samir Bhatt
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引用次数: 0

摘要

蚊子的生态学和疟原虫在蚊子体内的发育对天气,特别是温度和降水有着明显的敏感性。因此,气候变化预计将对疟疾流行病学的传播、时空分布和随之而来的疾病负担产生深远影响。然而,疟疾传播还受到其他因素(如城市化、经济学、遗传学、抗药性)的影响,这些因素共同构成了一个高度复杂的动态系统,其中任何单一因素的影响都具有高度不确定性。因此,在本研究中,我们旨在重新评估人们普遍认为气候变化将增加全球疟疾传播的证据。我们首先回顾了为这一证据基础做出贡献的不同类型的研究:i) 根据环境与蚊虫学之间的推断关系预测传播变化的研究;ii) 侧重于机理传播或时间序列模型的研究,以估计疟疾控制策略对流行率的影响;iii) 基于回归的研究,寻找环境变量与疟疾流行率之间的关联。然后,我们采用一个简单的统计模型来说明,环境变量本身并不能解释所观察到的疟疾流行率的时空变化。我们的综述对围绕气候变化和疟疾进行的宣传分析的稳健性提出了一些担忧。我们发现,虽然气候变化对疟疾的影响非常可信,但经验证据却不那么确定。未来有关气候变化和疟疾的研究必须与疟疾控制计划相结合,并作为影响疟疾的众多因素之一加以理解。我们的工作概述了建模方面的差距,我们认为这些差距是未来研究的重点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Climate Change and Malaria: A Call for Robust Analytics
Mosquito ecology and malaria parasite development in mosquitoes display marked sensitivity to weather, in particular to temperature and precipitation. Therefore, climate change is expected to profoundly affect malaria epidemiology in its transmission, spatiotemporal distribution and consequent disease burden. However, malaria transmission is also complicated by other factors (e.g.\ urbanisation, economics, genetics, drug resistance) which together constitute a highly complex, dynamical system, where the influence of any single factor is highly uncertain. In this study, we therefore aim to re-evaluate the evidence underlying the widespread belief that climate change will increase worldwide malaria transmission. We firstly review the different types of studies that have contributed to this evidence-base: i) studies that project changes in transmission due to inferred relationships between environmental and mosquito entomology; ii) studies that focus on either mechanistic transmission or time series models to estimate the effects of malaria control strategies on prevalence, and iii) regression-based studies that look for associations between environmental variables and malaria prevalence. We then employ a simple statistical model to show that environmental variables alone do not account for the observed spatiotemporal variation in malaria prevalence. Our review raises several concerns about the robustness of the analyses used for advocacy around climate change and malaria. We find that, while climate change's effect on malaria is highly plausible, empirical evidence is much less certain. Future research on climate change and malaria must become integrated into malaria control programs, and understood in context as one factor among many affecting malaria. Our work outlines gaps in modelling that we believe are priorities for future research.
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