High burden of malaria infection in pregnant women in a rural district of Zambia: a cross-sectional study
High burden of malaria infection in pregnant women in a rural district of Zambia: a cross-sectional study
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DOI：
10.1186/s12936-015-0866-1
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发表时间：
2015-09-30
期刊：
影响因子：
3
通讯作者：
Chico, R. Matthew
中科院分区：
文献类型：
--
作者：
Chaponda, Enesia Banda;Chandramohan, Daniel;Chico, R. Matthew
背景：疟疾仍然是低收入国家的一个主要健康问题。因此，控制疟疾仍然是赞比亚等疟疾流行国家的公共卫生优先事项。孕妇和5岁以下儿童是感染疟疾的高危人群。疟疾感染与影响母亲、胎儿和婴儿的不良出生结局有关。艾滋病毒感染已被证明会增加怀孕期间感染疟疾的风险。调查了赞比亚北部恩切伦格地区孕妇疟疾感染的流行情况和预测因素。方法：在2013年11月至2014年4月期间，在两家保健中心的集水区招募首次产前检查的孕妇。艾滋病毒检测作为常规护理的一部分进行。此外，还收集了1086名参与者的血液样本，并使用标准显微镜和恶性疟原虫特异性聚合酶链反应（PCR）技术检测疟疾感染。采用多因素logistic回归检验疟疾感染的预测因素。结果：镜检检出的疟疾患病率为31.8%(95%可信区间[CI]， 29.0 ~ 34.5, N = 1079)， PCR检出的疟疾患病率为57.8% （95% CI, 54.9 ~ 60.8, N = 1074）。在第一次产前检查时，艾滋病毒感染率为13.2%；经PCR检测，未感染艾滋病病毒和感染艾滋病病毒的妇女疟疾患病率分别为56.7%（531/936）和65.2%（90/ 138）。在最后的模型中，从Nchelenge保健中心招募的孕妇感染疟疾的风险比在Kashikishi保健中心招募的孕妇高81%（调整后的优势比= 1.81;95% CI, 1.38-2.37, P < 0.001），而各保健中心感染艾滋病毒的妇女感染疟疾的风险比未感染艾滋病毒的妇女高46%（调整后的优势比= 1.46;95%,1.00-2.13,P = 0.045）。结论：PCR检测到这些孕妇疟疾负担高，表明以往的预防工作效果有限。为了可持续地减少这种疟疾负担，显然需要加强现有的干预措施，并可能改变方法，以便更好地针对受疟疾影响最严重的群体。
Background: Malaria continues to be a major health problem in low-income countries. Consequently, malaria control remains a public health priority in endemic countries such as Zambia. Pregnant women and children under 5 years of age are among groups at high risk of malaria infection. Malaria infection is associated with adverse birth outcomes that affect the mother, foetus, and infant. Infection with HIV has been shown to increase the risk of malaria infection in pregnancy. The prevalence and the predictors of malaria infection among pregnant women resident in the Nchelenge District of northern Zambia were investigated.Methods: Between November 2013 and April 2014, pregnant women in the catchment areas of two health centres were recruited during their first antenatal care visit. HIV testing was conducted as part of routine care. In addition, blood samples were collected from 1086 participants and tested for malaria infection using standard microscopy and polymerase chain reaction (PCR) techniques specific for Plasmodium falciparum. Multivariate logistic regression were conducted to examine the predictors of malaria infection.Results: The prevalence of malaria identified by microscopy was 31.8 % (95 % confidence intervals [CI], 29.0-34.5; N = 1079) and by PCR was 57.8 % (95 % CI, 54.9-60.8; N = 1074). HIV infection was 13.2 % among women on their first antenatal visit; the prevalence of malaria detected by PCR among HIV-uninfected and HIV- infected women was 56.7 % (531/936) and 65.2 % (90/ 138), respectively. In the final model, the risk of malaria infection was 81 % higher among pregnant women recruited from Nchelenge health centre compared to those attending the Kashikishi health centre (adjusted odds ratio = 1.81; 95 % CI, 1.38-2.37, P < 0.001), and HIV-infected women across health centres had a 46 % greater risk of malaria infection compared to HIV-uninfected women (adjusted odds ratio = 1.46; 95 %, 1.00-2.13, P = 0.045).Conclusion: High burden of malaria detected by PCR in these pregnant women suggests that past prevention efforts have had limited effect. To reduce this burden of malaria sustainably, there is clear need to strengthen existing interventions and, possibly, to change approaches so as to improve targeting of groups most affected by malaria.