Hookworm-related anaemia among pregnant women: a systematic review.
Hookworm-related anaemia among pregnant women: a systematic review.
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DOI：
10.1371/journal.pntd.0000291
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发表时间：
2008-09-17
影响因子：
3.8
通讯作者：
Bundy DA
中科院分区：
文献类型：
--
作者：
Brooker S;Hotez PJ;Bundy DA
钩虫感染是贫困社区贫血的主要原因之一，但人们对钩虫感染在造成孕产妇贫血方面的重要性知之甚少，这阻碍了将驱虫药纳入孕产妇保健一揽子计划的有效游说。我们试图回顾关于钩虫是孕妇贫血的危险因素的现有证据。我们还估计了撒哈拉以南非洲(SSA)孕妇感染钩虫的数量。使用MEDLINE和EMBASE进行结构化搜索以及手动搜索参考文献列表，并通过联系作者获得未发表的数据。论文由两位作者独立审阅，并提取相关数据。我们根据钩虫感染的强度比较血红蛋白浓度(Hb)，并计算标准化的平均差值和95%的可信区间。为了估计怀孕妇女的数量，我们使用了人口表面和钩虫流行的空间模型。共筛选了105篇报告，其中19篇符合纳入条件：13篇横断面研究、2篇随机对照试验、2篇非随机治疗试验和2篇观察性研究。比较未感染钩虫妇女和轻度钩虫感染妇女(1~1,999个虫卵/克)，标化平均差为−0.24(95%CI：−0.36至−0.13)。重度感染者与轻度感染者的SMD值分别为−0.57(95%CI：−0.87~−0.26)。所有已确定的干预研究都表明驱虫对孕产妇或儿童健康有好处，但由于采用了各种结果衡量标准，量化评估是不可能的。我们估计，2005年，南非有3770万育龄妇女感染钩虫，约690万孕妇感染。有证据表明，在贫穷国家，钩虫感染强度的增加与孕妇的血红蛋白水平降低有关。没有足够的数据来量化驱虫的好处，进一步的研究是有必要的。鉴于SSA四分之一至三分之一的孕妇感染了钩虫，并面临可预防的钩虫相关性贫血的风险，应努力增加孕妇驱虫治疗的覆盖面。贫血影响了发展中国家的大量孕妇，增加了她们在怀孕期间死亡和分娩低出生体重儿的风险，而这些婴儿的死亡风险也随之增加。长期以来，人类钩虫感染一直被认为是贫困社区贫血的主要原因之一，但对孕期钩虫感染管理的益处的了解一直落后于导致孕产妇贫血的其他主要原因。其结果是，在许多国家的孕产妇保健方案中驱虫药治疗覆盖率很低。在系统回顾现有文献后，我们观察到钩虫感染强度的增加与孕妇中较低的血红蛋白水平有关。我们还估计，撒哈拉以南非洲四分之一至三分之一的孕妇感染了钩虫，并面临可预防的钩虫相关贫血的风险。然而，所有已确定的干预研究都表明驱虫对孕产妇或儿童健康有好处，我们认为应该加大努力，增加孕妇驱虫治疗的覆盖面。
Hookworm infection is among the major causes of anaemia in poor communities, but its importance in causing maternal anaemia is poorly understood, and this has hampered effective lobbying for the inclusion of anthelmintic treatment in maternal health packages. We sought to review existing evidence on the role of hookworm as a risk factor for anaemia among pregnant women. We also estimate the number of hookworm infections in pregnant women in sub-Saharan Africa (SSA). Structured searches using MEDLINE and EMBASE as well as manual searches of reference lists were conducted, and unpublished data were obtained by contacting authors. Papers were independently reviewed by two authors, and relevant data were extracted. We compared haemoglobin concentration (Hb) according to intensity of hookworm infection and calculated standardised mean differences and 95% confidence intervals. To estimate the number of pregnant women, we used population surfaces and a spatial model of hookworm prevalence. One hundred and five reports were screened and 19 were eligible for inclusion: 13 cross-sectional studies, 2 randomised controlled trials, 2 non-randomised treatment trials and 2 observational studies. Comparing uninfected women and women lightly (1–1,999 eggs/gram [epg]) infected with hookworm, the standardised mean difference (SMD) was −0.24 (95% CI: −0.36 to −0.13). The SMD between women heavily (4000+ epg) infected and those lightly infected was −0.57 (95% CI: −0.87 to −0.26). All identified intervention studies showed a benefit of deworming for maternal or child health, but since a variety of outcomes measures were employed, quantitative evaluation was not possible. We estimate that 37.7 million women of reproductive age in SSA are infected with hookworm in 2005 and that approximately 6.9 million pregnant women are infected. Evidence indicates that increasing hookworm infection intensity is associated with lower haemoglobin levels in pregnant women in poor countries. There are insufficient data to quantify the benefits of deworming, and further studies are warranted. Given that between a quarter and a third of pregnant women in SSA are infected with hookworm and at risk of preventable hookworm-related anaemia, efforts should be made to increase the coverage of anthelmintic treatment among pregnant women. Anaemia affects large numbers of pregnant women in developing countries and increases their risk of dying during pregnancy and delivering low birth weight babies, who in turn are at increased risk of dying. Human hookworm infection has long been recognized among the major causes of anaemia in poor communities, but understanding of the benefits of the management of hookworm infection in pregnancy has lagged behind the other major causes of maternal anaemia. Low coverage of anthelmintic treatment in maternal health programmes in many countries has been the result. After systematically reviewing the available literature we observed that increasing hookworm infection intensity is associated with lower haemoglobin levels in pregnant women. We also estimate that between a quarter and a third of pregnant women in sub-Saharan Africa are infected with hookworm and at risk of preventable hookworm-related anaemia. However, all identified intervention studies showed a benefit of deworming for maternal or child health and we argue that increased efforts should be made to increase the coverage of anthelmintic treatment among pregnant women.
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影响因子：
158.5
作者：
Calis, Job C. J.;Phiri, Kamija S.;van Hensbroek, Michael Boele
通讯作者：
van Hensbroek, Michael Boele
全球流行病学，生态学和控制土壤传播的蠕虫感染。
影响因子：
--
作者：
Brooker, S.;Clements, A. C. A.;Bundy, D. A. P.
通讯作者：
Bundy, D. A. P.
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
7.1
作者：
Allen, LH
通讯作者：
Allen, LH
影响因子：
168.9
作者：
de Silva, NR;Sirisena, JLGJ;de Silva, HJ
通讯作者：
de Silva, HJ