Effect of group versus individual antenatal care on uptake of intermittent prophylactic treatment of malaria in pregnancy and related malaria outcomes in Nigeria and Kenya: analysis of data from a pragmatic cluster randomized trial
Effect of group versus individual antenatal care on uptake of intermittent prophylactic treatment of malaria in pregnancy and related malaria outcomes in Nigeria and Kenya: analysis of data from a pragmatic cluster randomized trial
复制标题
DOI：
10.1186/s12936-020-3099-x
复制
发表时间：
2020-01-29
期刊：
影响因子：
3
通讯作者：
Adetiloye, Oniyire
中科院分区：
文献类型：
--
作者：
Noguchi, Lisa;Grenier, Lindsay;Adetiloye, Oniyire
每年，妊娠期疟疾导致撒哈拉以南非洲约20%的死产和全球10，000例孕产妇死亡。大多数符合条件的孕妇没有接受最低三个推荐剂量的磺胺嘧啶-乙胺嘧啶间歇性预防治疗。本分析的目的是确定随机分组产前护理（G-ANC）与标准产前护理（ANC）的妇女在IPT吸收和经杀虫剂处理的蚊帐（ITN）使用方面是否存在差异。方法对来自G-ANC研究的前瞻性数据进行分析，该研究是一项务实的、随机分组的对照试验，旨在调查G-ANC对各种孕产妇新生儿健康相关结局的影响。通过记录摘要收集关于IPTp的数据，并通过t检验计算每个国家研究组之间平均给药次数的差异。通过产后访谈收集ITN使用数据，并使用双样本比例检验计算两组之间的差异。结果分别对来自尼日利亚和肯尼亚的1075名妇女和419名妇女的数据进行了分析：在尼日利亚，535名（49.8%）接受了G-ANC，540名（50.2%）接受了个体ANC;在肯尼亚，211名（50.4%）接受了G-ANC，208名（49.6%）接受了个体ANC。在尼日利亚（3.45对2.14，p < 0.001）和肯尼亚（3.81对2.72，p <0.001），干预组接受的平均IPTp剂量高于对照组。据报告，尼日利亚和肯尼亚的母亲在前一天晚上使用驱虫蚊帐的比例同样很高（超过92%）。在尼日利亚，干预组报告的婴儿ITN使用率高于对照组（82.7% vs 75.8%，p = 0.020）。结论G-ANC可能支持更好的IPTp-SP摄取，可能与更好的ANC保留有关。然而，需要进一步研究，以了解对使用驱虫蚊帐的影响。试验注册泛非临床试验注册中心，2017年5月2日（PACTR 201706002254227）。
Background Every year, malaria in pregnancy contributes to approximately 20% of stillbirths in sub-Saharan Africa and 10,000 maternal deaths globally. Most eligible pregnant women do not receive the minimum three recommended doses of intermittent preventive treatment with Sulfadoxine-pyrimethamine (IPTp-SP). The objective of this analysis was to determine whether women randomized to group antenatal care (G-ANC) versus standard antenatal care (ANC) differed in IPTp uptake and insecticide-treated nets (ITN) use. Methods Prospective data were analysed from the G-ANC study, a pragmatic, cluster randomized, controlled trial that investigated the impact of G-ANC on various maternal newborn health-related outcomes. Data on IPTp were collected via record abstraction and difference between study arms in mean number of doses was calculated by t test for each country. Data on ITN use were collected via postpartum interview, and difference between arms calculated using two-sample test for proportions. Results Data from 1075 women and 419 women from Nigeria and Kenya, respectively, were analysed: 535 (49.8%) received G-ANC and 540 (50.2%) received individual ANC in Nigeria; 211 (50.4%) received G-ANC and 208 (49.6%) received individual ANC in Kenya. Mean number of IPTp doses received was higher for intervention versus control arm in Nigeria (3.45 versus 2.14, p < 0.001) and Kenya (3.81 versus 2.72, p < 0.001). Reported use of ITN the previous night was similarly high in both arms for mothers in Nigeria and Kenya (over 92%). Reported ITN use for infants was higher in the intervention versus control arm in Nigeria (82.7% versus 75.8%, p = 0.020). Conclusions G-ANC may support better IPTp-SP uptake, possibly related to better ANC retention. However, further research is needed to understand impact on ITN use. Trial registration Pan African Clinical Trials Registry, May 2, 2017 (PACTR201706002254227).