Table 1_Burden of malaria in the Comoros, 1990–2021: findings from the global burden of disease study 2021.xlsx

BackgroundMalaria is a major public health issue in the Comoros. Analyzing the malaria burden will aid in designing prevention, control, and eradication strategies based on scientific evidence.
MethodsWe retrieved data from the 2021 Global Burden of Disease (GBD) database to assess the malaria burden in the Comoros in 2021, stratified by sex and age. The indicators used to measure this burden included the absolute numbers and rates of incidence, prevalence, and mortality, as well as disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). Decomposition analysis was used to quantify the contributions of demographic aging, population growth, and epidemiological changes to the malaria burden from 1990 to 2021. Joinpoint regression analysis was employed to examine temporal trends in the malaria burden over this period.
ResultsIn 2021, females, particularly those under 40, had a higher overall malaria burden than males, except for the age-standardized incidence rate (ASIR) and the age-standardized mortality rate (ASMR). Individuals under 30 years of age experienced approximately 52% of new malaria episodes, 68% of prevalent cases, and 62% of YLDs. Children under 5 and those aged 15 to 30 accounted for about 41% of malaria-related deaths, 54% of YLLs, and 53% of DALYs. Between 1990 and 2021, the malaria burden in the Comoros declined substantially, with age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and DALY rates (ASDR) decreasing by over 85%. Decomposition analysis indicated that epidemiological changes played a pivotal role in reducing disease burden. Over the past 32 years, the average annual percentage change (AAPC) in the ASPR was statistically significant at −7.60% (t = −2.68, p < 0.05). Moreover, the annual percentage change (APC) in ASIR and ASPR showed the most significant decline from 2012 to 2015, with APCs of −70.47% (t = −3.01, p < 0.05) and − 66.55% (t = −14.94, p < 0.05), respectively.
ConclusionThis study indicates that women under 40, school-aged children, and adults under 30 in the Comoros bear a higher malaria burden. Although current malaria control measures are effective, achieving a malaria-free status will require integrated strategies.

背景：疟疾是科摩罗地区的重大公共卫生问题。对疟疾负担开展分析，可为基于科学证据制定疟疾预防、控制及消除策略提供科学支撑。
方法：本研究从2021年全球疾病负担（Global Burden of Disease, GBD）数据库中获取数据，对2021年科摩罗的疟疾负担进行评估，评估按性别及年龄分层进行。用于衡量疟疾负担的指标包括发病、患病、死亡的绝对数与率，以及伤残调整寿命年（disability-adjusted life years, DALYs）、寿命损失年（years of life lost, YLLs）和伤残生存年（years lived with disability, YLDs）。本研究采用分解分析方法，量化1990年至2021年期间人口老龄化、人口增长和流行病学变化对疟疾负担的贡献；同时采用连接点回归分析（Joinpoint regression analysis），考察该时期疟疾负担的时间变化趋势。
结果：2021年，除年龄标准化发病率（age-standardized incidence rate, ASIR）和年龄标准化死亡率（age-standardized mortality rate, ASMR）外，女性（尤其是40岁以下女性）的整体疟疾负担高于男性。30岁以下人群占新发疟疾病例的约52%、现患病例的68%以及伤残生存年的62%。5岁以下儿童与15至30岁人群占疟疾相关死亡的约41%、寿命损失年的54%以及伤残调整寿命年的53%。1990年至2021年间，科摩罗的疟疾负担大幅下降，年龄标准化发病率（ASIR）、年龄标准化患病率（age-standardized prevalence rate, ASPR）、年龄标准化死亡率（ASMR）以及伤残调整寿命年率（age-standardized DALY rate, ASDR）均下降超85%。分解分析结果显示，流行病学变化在疾病负担降低过程中发挥了关键作用。过去32年间，年龄标准化患病率的平均年度变化百分比（average annual percentage change, AAPC）为-7.60%，且具有统计学意义（t=-2.68，p<0.05）。此外，2012年至2015年期间，年龄标准化发病率与患病率的年度变化百分比（annual percentage change, APC）下降最为显著，分别为-70.47%（t=-3.01，p<0.05）和-66.55%（t=-14.94，p<0.05）。
结论：本研究表明，科摩罗地区40岁以下女性、学龄儿童及30岁以下成人的疟疾负担更高。尽管当前的疟疾防控措施已取得良好成效，但实现无疟疾状态仍需采取综合防控策略。