Malaria associated symptoms in pregnant women followed-up in Benin
Malaria associated symptoms in pregnant women followed-up in Benin
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DOI：
10.1186/1475-2875-10-72
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发表时间：
2011-03-31
期刊：
影响因子：
3
通讯作者：
Cot, Michel
中科院分区：
文献类型：
--
作者：
Bich-Tram Huynh;Fievet, Nadine;Cot, Michel
背景：人们普遍认为，在疟疾高传播地区，孕妇对疟疾具有部分免疫力，感染后很少出现症状或没有症状。然而，缺乏对稳定流行区孕妇疟疾感染临床表现的纵向队列研究，探讨这一问题的少数研究也不是决定性的。方法：2008年8月至2010年9月，在贝宁的三家农村药房进行了前瞻性队列妇女孕期每月跟踪调查。对982例孕妇在产前检查(ANV)、计划外检查和分娩期间出现疟疾感染症状进行了分析。结果：在常规ANVS中，头痛是唯一与TBS阳性风险相关的症状(aOR=1.9p<；0.001)。在计划外就诊时，发热(aor5.2；p<；0.001)、头痛(aor2.1；p=0.004)和寒战(aor3.1；p<；0.001)与疟疾感染显著相关，几乎90%的受感染妇女至少出现其中一种症状。在计划外就诊期间，三分之二的有症状疟疾感染发生在妊娠晚期和最后一次间歇预防治疗剂量(IPTp)之后很长一段时间。结论：在疟疾流行稳定地区，大多数孕妇在常规就诊期间没有任何症状。疟疾(发烧)的唯一暗示迹象是只有在非计划访问的情况下才与疟疾有关。通过重新评估IPTp的设计，即确定抗疟疾药物的最佳剂量和给药时间，可以改进孕期疟疾的预防。
Background: It is generally agreed that in high transmission areas, pregnant women have acquired a partial immunity to malaria and when infected they present few or no symptoms. However, longitudinal cohort studies investigating the clinical presentation of malaria infection in pregnant women in stable endemic areas are lacking, and the few studies exploring this issue are unconclusive.Methods: A prospective cohort of women followed monthly during pregnancy was conducted in three rural dispensaries in Benin from August 2008 to September 2010. The presence of symptoms suggestive of malaria infection in 982 women during antenatal visits (ANV), unscheduled visits and delivery were analysed. A multivariate logistic regression was used to determine the association between symptoms and a positive thick blood smear (TBS).Results: During routine ANVs, headache was the only symptom associated with a higher risk of positive TBS (aOR = 1.9; p < 0.001). On the occasion of unscheduled visits, fever (aOR = 5.2; p < 0.001), headache (aOR = 2.1; p = 0.004) and shivering (aOR = 3.1; p < 0.001) were significantly associated with a malaria infection and almost 90% of infected women presented at least one of these symptoms. Two thirds of symptomatic malaria infections during unscheduled visits occurred in late pregnancy and long after the last intermittent preventive treatment dose (IPTp).Conclusion: The majority of pregnant women were symptomless during routine visits when infected with malaria in an endemic stable area. The only suggestive sign of malaria (fever) was associated with malaria only on the occasion of unscheduled visits. The prevention of malaria in pregnancy could be improved by reassessing the design of IPTp, i.e. by determining an optimal number of doses and time of administration of anti-malarial drugs.