Failure of a chloroquine chemoprophylaxis program to adequately prevent malaria during pregnancy in Koupela District, Burkina Faso
Failure of a chloroquine chemoprophylaxis program to adequately prevent malaria during pregnancy in Koupela District, Burkina Faso
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DOI：
10.1086/375077
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发表时间：
2003-06-01
影响因子：
11.8
通讯作者：
Newman, RD
中科院分区：
文献类型：
--
作者：
Sirima, SB;Sawadogo, R;Newman, RD
在西非，怀孕期间给予氯喹化学预防是常见的，但对其对怀孕期间恶性疟原虫感染的影响知之甚少。因此，在布基纳法索库佩拉区进行了产前保健诊所（ANCs）和分娩单位（DUs）的横断面研究。597名anc孕妇中有69%报告使用氯喹化学预防，853名DUs孕妇中有93%报告使用氯喹化学预防。在anc和DUs中，29%的妇女都发现了恶性疟原虫外周寄生虫血症。胎盘寄生虫血症在22%的分娩妇女中被发现，并与低出生体重（LBW）（风险比[RR]， 1.7； 95%可信区间[CI]， 1.2-2.4）和早产（RR, 2.9； 95%可信区间[CI]， 1.6-5.4）密切相关。在多变量分析中，使用化学预防与胎盘寄生虫血症、LBW或早产发生率的降低无关。尽管报道的氯喹化学预防覆盖率很高，但外周和胎盘疟疾发病率仍然很高，并与妊娠期间已知的不良后果有关，包括孕产妇贫血、早产和低体重儿。需要采取替代预防战略，例如使用驱虫蚊帐和使用更有效的抗疟药物进行间歇性预防治疗。
In West Africa, administration of chloroquine chemoprophylaxis during pregnancy is common, but little is known about its impact on Plasmodium falciparum infection during pregnancy. Therefore, cross-sectional studies in antenatal care clinics (ANCs) and delivery units (DUs) were conducted in Koupela District, Burkina Faso. Chloroquine chemoprophylaxis was reported by 69% of 597 pregnant women at ANCs and by 93% of 853 women in DUs. P. falciparum peripheral parasitemia was identified in 29% of women at both ANCs and DUs. Placental parasitemia was identified in 22% of delivering women and was strongly associated with low birth weight (LBW) ( risk ratio [RR], 1.7; 95% confidence interval [CI], 1.2-2.4) and prematurity (RR, 2.9; 95% CI, 1.6-5.4). In multivariate analysis, use of chemoprophylaxis was not associated with a reduction in the prevalence of placental parasitemia, LBW, or prematurity. Despite the high reported chloroquine chemoprophylaxis coverage, peripheral and placental malaria rates remain high and are associated with known adverse outcomes during pregnancy, including maternal anemia, prematurity, and LBW. Alternative prevention strategies, such as use of insecticide-treated mosquito nets and intermittent preventive treatment with more-effective antimalarials, are needed.