Value of additional chemotherapy for malaria in pregnancy.
Value of additional chemotherapy for malaria in pregnancy.
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妊娠期疟疾额外化疗的价值。
DOI：
10.1016/s2214-109x(15)70081-1
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Walker PG
中科院分区：
文献类型：
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作者：
Walker PG
在《柳叶刀全球健康》杂志上，Silke Fernandes及其同事1对世卫组织目前建议的将妊娠期疟疾间歇预防性治疗（IPTp）的剂量从两剂增加到三剂或更多剂量的成本效益进行了重要而及时的评估。该分析提供了令人信服的证据，表明在非洲大多数疟疾持续传播地区，如果将孕妇在怀孕期间接受额外剂量的磺胺多辛乙胺嘧啶（SP）作为标准产前保健的一部分，低出生体重的逐渐减少将具有很高的成本效益。证明每月IPTp-SP具有成本效益对研究人员和政策制定者都很重要，这一结果对改善该地区孕妇及其婴儿的健康具有明确的意义。据估计，2010年这些地区发生了3200万例怀孕3，如果这些妇女得不到保护免受感染，就有可能导致约70万例因疟疾导致的低出生体重分娩。然而，关于如何最好地在怀孕期间提供预防疟疾的保护，仍然存在一些关键问题。也许最紧迫的问题是，尽管IPTp- sp具有明显的成本效益，以前建议的两剂5和产前保健覆盖率现在在非洲大部分地区都很高，但在许多地区，接受甚至两个疗程IPTp的妇女比例仍然很低。正如作者提出的那样，这种低吸收的一个因素可能是对SP的耐药性的出现，特别是在东非。在这种情况下，SP对病例管理不再有效，而将SP视为无效药物的看法可能会破坏IPTp-SP。这一因素促使研究人员寻找IPTp-SP的替代方案，例如使用更有效或更持久的青蒿素联合疗法（ACTs），要么基于产前保健检查中快速诊断测试（RDT）的阳性诊断，要么作为一种替代的推定疗法。令人欣慰的是，SP对低出生体重仍然有效，这是本分析中成本效益的主要决定因素，除了最高度耐药的地区（6个序列赋予的超级耐药）
In The Lancet Global Health, Silke Fernandes and colleagues1 provide an important and timely assessment of the cost-effectiveness of increasing the doses of intermittent preventive treatment for malaria during pregnancy (IPTp) from two doses to three or more doses, as currently recommended by the WHO. This analysis provides compelling evidence that the incremental reduction in low birthweight noted in women who receive additional doses of sulfadoxine pyrimethamine (SP) during pregnancy2 will be highly cost-effective when included as part of standard antenatal care in most areas of sustained malaria transmission in Africa.The demonstration that monthly IPTp-SP is cost-effective is important to both researchers and policymakers, and this result has clear implications for improving the health of both expectant mothers and their infants in this region. An estimated 32 million pregnancies occurred in such areas in 2010, 3 which would have the potential to lead to an estimated 0· 7 million low birthweight deliveries attributable to malaria if these women were not protected from infection. 4 However, some key questions remain concerning how best to provide protection from malaria during pregnancy. Perhaps the most pressing is why, despite IPTp-SP having demonstrable cost-effectiveness with the previously recommended two doses5 and antenatal care coverage now being high across much of Africa, the proportion of women receiving even two courses of IPTp in many areas remains low. 6 As the authors suggest, one contributing factor to this low uptake might be the emergence of resistance to SP, particularly in eastern Africa. SP is no longer efficacious for case management in such settings, and perception of SP as an ineffective drug might be undermining IPTp-SP. This factor has prompted researchers to look at alternatives to IPTp-SP such as the use of more efficacious or longer-lasting artemisinin combination therapies (ACTs), either on the basis of positive diagnosis from a rapid diagnostic test (RDT) at an antenatal care visit, or as an alternative presumptive therapy. 7 It is reassuring that SP remains effective against low birthweight, the main determinant of cost-effectiveness in this analysis, in all but the most highly resistant areas (those with super-resistance conferred by six sequential