Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa
Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa
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DOI：
10.1016/s0035-9203(01)90082-3
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发表时间：
2001-11-01
影响因子：
2.2
通讯作者：
Snow, RW
中科院分区：
文献类型：
--
作者：
Guyatt, HL;Snow, RW
尽管减少妊娠期疟疾干预措施的随机对照试验表明，初产妇新生儿的出生体重有所增加，但随后对所有胎次的婴儿死亡率的影响尚未评估。本文的目的是模拟胎盘疟疾感染通过降低出生体重对婴儿死亡率可能产生的影响。我们进行了广泛的文献检索，以确定一系列描述撒哈拉以南非洲地区胎盘感染、出生体重和过早死亡率之间关系的参数。研究表明，如果母亲在分娩时胎盘受感染，则出生时低出生体重的婴儿的可能性会增加一倍（所有胎次：23% vs 11%，仅初产妇：32% vs 16%），非洲新生儿出生第一年过早死亡的概率是正常出生体重婴儿的 3 倍（16% vs 4.6%）。假设非洲疟疾流行地区25%的孕妇存在胎盘疟疾感染，则表明疟疾地区5.7%的婴儿死亡可能是妊娠期疟疾的间接原因。这意味着，1997 年，在肯尼亚不同的流行病学条件下，妊娠期疟疾可能导致约 3700 名婴儿死亡。恶性疟原虫胎盘感染对非洲婴儿生存的影响似乎比之前的假设更为重要。这可能解释了旨在减少传播的干预措施导致婴儿死亡率大幅下降的原因，超出了单独疟疾特异性死亡率下降的预期。
Although randomized controlled trials of interventions to reduce malaria in pregnancy have demonstrated an increase in the birthweight of the newborn in primigravidae, the subsequent impact on infant mortality in all-parities has not been assessed. The aim of this paper was to model the possible impact of placental malarial infection on infant mortality through reduced birthweight. An extensive literature search was undertaken to define a series of parameters describing the associations between placental infection, birthweight and premature mortality in sub-Saharan Africa. It was shown that a baby is twice as likely to be born of low birthweight if the mother has an infected placenta at the time of delivery (all-parities: 23% vs 11 %, primigravidae only: 32% vs 16%), and that the probability of premature mortality of African newborns in the first year of life is 3 times higher in babies of low birthweight than in those of normal birthweight (16% vs 4.6%). Assuming 25% of pregnant women in malaria-endemic areas of Africa harbour placental malarial infection, it is suggested that 5.7% of infant deaths in malarious areas could be an indirect cause of malaria in pregnancy. This would imply that, in 1997, malaria in pregnancy could have been responsible for around 3700 infant deaths under the diverse epidemiological conditions in Kenya. Placental infection with Plasmodium falciparum appears to have a more significant role in infant survival in Africa than has been previously assumed. This may explain the high reduction in infant mortality rates from interventions aimed at reducing transmission, over and above that expected from a decline in direct malaria-specific mortality alone.