Seasonal Dynamics of Malaria in Pregnancy in West Africa: Evidence for Carriage of Infections Acquired Before Pregnancy Until First Contact with Antenatal Care.
Seasonal Dynamics of Malaria in Pregnancy in West Africa: Evidence for Carriage of Infections Acquired Before Pregnancy Until First Contact with Antenatal Care.
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DOI：
10.4269/ajtmh.17-0620
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Cairns M
中科院分区：
文献类型：
--
作者：
Berry I;Walker P;Tagbor H;Bojang K;Coulibaly SO;Kayentao K;Williams J;Oduro A;Milligan P;Chandramohan D;Greenwood B;Cairns M
在疟疾流行地区，恶性疟原虫在年轻女性中的流行率往往很高，原因是1)首次怀孕前使用经杀虫剂处理的蚊帐很少，2)获得免疫力，这意味着感染没有症状，因此没有治疗。因此，妊娠期疟疾(MiP)的一个常见来源可能是怀孕的受感染妇女，而不是受到感染的孕妇。在这项研究中，在加纳、布基纳法索、马里和冈比亚这四个传播有强烈季节性变化的国家，通过第一次产前护理(ANC)就诊时的显微镜检查确定了初产妇和继发性孕妇的感染率。用多变量Poisson回归对雨季妊娠时间和其他感染危险因素进行评估。我们发现，最初ANC疟疾的总体流行率普遍很高，并随着雨季怀孕时间的延长而增加：接触时间最长的人的流行率在加纳为59.7%，在布基纳法索为56.7%，在马里为42.2%，在冈比亚为16.8%。然而，即使在第一次ANC之前整个怀孕都发生在旱季的妇女中，发病率也很高：在这四个国家，分别为41.3%、34.4%、11.5%和7.8%。在多变量分析中，感染风险在初产妇、年轻女性和社会经济地位较低的人群中也较高，与季节性无关。在怀孕期间没有暴露于高传播率的妇女中的高流行率表明，MIP负担的部分原因是长期感染，包括后天获得的先入性感染。需要在孕前预防疟疾，以减少MIP负担。
In malaria-endemic areas, Plasmodium falciparum prevalence is often high in young women because of 1) low use of insecticide-treated nets before their first pregnancy and 2) acquired immunity, meaning infections are asymptomatic and thus untreated. Consequently, a common source of malaria in pregnancy (MiP) may be infected women becoming pregnant, rather than pregnant women becoming infected. In this study, prevalence of infection was determined by microscopy at first antenatal care (ANC) visit in primigravidae and secundigravidae in Ghana, Burkina Faso, Mali, and The Gambia, four countries with strong seasonal variations in transmission. Duration of pregnancy spent in the rainy season and other risk factors for infection were evaluated using multivariable Poisson regression. We found that the overall prevalence of malaria at first ANC was generally high and increased with time spent pregnant during the rainy season: prevalence among those with the longest exposure was 59.7% in Ghana, 56.7% in Burkina Faso, 42.2% in Mali, and 16.8% in Gambia. However, the prevalence was substantial even among women whose entire pregnancy before first ANC had occurred in the dry season: 41.3%, 34.4%, 11.5%, and 7.8%, respectively, in the four countries. In multivariable analysis, risk of infection was also higher among primigravidae, younger women, and those of lower socioeconomic status, independent of seasonality. High prevalence among women without exposure to high transmission during their pregnancy suggests that part of the MiP burden results from long-duration infections, including those acquired preconception. Prevention of malaria before pregnancy is needed to reduce the MiP burden.
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