Decreasing burden of malaria in pregnancy in Malawian women and its relationship to use of intermittent preventive therapy or bed nets.
Decreasing burden of malaria in pregnancy in Malawian women and its relationship to use of intermittent preventive therapy or bed nets.
复制标题
DOI：
10.1371/journal.pone.0012012
复制
发表时间：
2010-08-06
期刊：
影响因子：
3.7
通讯作者：
Rogerson SJ
中科院分区：
文献类型：
--
作者：
Feng G;Simpson JA;Chaluluka E;Molyneux ME;Rogerson SJ
世界卫生组织建议使用驱虫蚊帐和间歇性预防性治疗来减少怀孕期间的疟疾。疟疾流行率和妊娠结果的纵向数据对于衡量这些抗疟干预措施的影响很有价值。我们招募了8,131名在马拉维一家医院分娩的妇女，时间超过9年。我们记录了人口统计学数据，产前处方的间歇性预防性治疗在怀孕期间与磺胺嘧啶乙胺嘧啶和蚊帐的使用，并检查手指刺血疟原虫和血红蛋白浓度。在4,712名妇女中，我们检查了胎盘血液中的疟疾寄生虫，并记录了婴儿的出生体重。外周血和胎盘寄生虫血症患病率分别从23.5%和25.2%下降到5.0%和6.8%。低出生体重和贫血的发生率下降幅度较小。增加了间歇性预防治疗和蚊帐的覆盖面。1997-2001年，磺胺嘧啶-乙胺嘧啶剂量与胎盘寄生虫血症（比值比（95% CI）：0.79（0.68，0.91））、母体贫血（0.81，（0.73，0.90））和低出生体重（0.63（0.53，0.75））呈负相关，但2002-2006年则不相关。在整个研究期间，使用蚊帐可防止外周寄生虫血症（0.47，（0.37，0.60））和胎盘寄生虫血症（0.41，（0.31，0.54））和低出生体重（0.75（0.59，0.95）），但不能防止贫血。与没有蚊帐的妇女和没有接受2剂磺胺嘧啶-乙胺嘧啶的妇女相比，使用蚊帐并接受2剂磺胺嘧啶-乙胺嘧啶的妇女患寄生虫血症或低出生体重婴儿的可能性较小。仅接受2剂磺胺嘧啶-乙胺嘧啶的妇女几乎没有保护的证据，而仅蚊帐提供了中等保护。蚊帐覆盖率的增加比磺胺嘧啶-乙胺嘧啶的使用更能解释孕妇寄生虫血症和出生体重的变化。蚊帐覆盖率高和磺胺嘧啶-乙胺嘧啶抗药性可能是造成其明显失效的原因。
The World Health Organization recommends insecticidal bednets and intermittent preventive treatment to reduce malaria in pregnancy. Longitudinal data of malaria prevalence and pregnancy outcomes are valuable in gauging the impact of these antimalarial interventions. We recruited 8,131 women delivering in a single Malawian hospital over 9 years. We recorded demographic data, antenatal prescription of intermittent preventive therapy during pregnancy with sulfadoxine-pyrimethamine and bed net use, and examined finger-prick blood for malaria parasites and hemoglobin concentration. In 4,712 women, we examined placental blood for malaria parasites and recorded the infant's birth weight. Peripheral and placental parasitemia prevalence declined from 23.5% to 5.0% and from 25.2% to 6.8% respectively. Smaller declines in prevalence of low birth weight and anemia were observed. Coverage of intermittent preventive treatment and bednets increased. Number of sulfadoxine-pyrimethamine doses received correlated inversely with placental parasitemia (Odds Ratio (95% CI): 0.79 (0.68, 0.91)), maternal anemia (0.81, (0.73, 0.90)) and low birth weight from 1997–2001 (0.63 (0.53, 0.75)), but not from 2002–2006. Bednet use protected from peripheral parasitemia (0.47, (0.37, 0.60)) and placental parasitemia (0.41, (0.31, 0.54)) and low birth weight (0.75 (0.59, 0.95)) but not anemia throughout the study. Compared to women without nets who did not receive 2-dose sulfadoxine-pyrimethamine, women using nets and receiving 2-dose sulfadoxine-pyrimethamine were less likely to have parasitemia or low birth weight babies. Women receiving 2-dose sulfadoxine-pyrimethamine alone had little evidence of protection whereas bednets alone gave intermediate protection. Increased bednet coverage explains changes in parasitemia and birth weight among pregnant women better than sulfadoxine-pyrimethamine use. High bed net coverage, and sulfadoxine-pyrimethamine resistance, may be contributing to its apparent loss of effectiveness.
登录
查看更多内容
影响因子：
2.7
作者：
Nkhoma, Standwell;Molyneux, Malcolm;Ward, Stephen
通讯作者：
Ward, Stephen
影响因子：
3.8
作者：
Mwapasa, Victor;Rogerson, Stephen J.;Meshnick, Steven R.
通讯作者：
Meshnick, Steven R.
DOI：
10.1073/pnas.0901415106
发表时间：
2009-06-02
影响因子：
11.1
作者：
Harrington, W. E.;Mutabingwa, T. K.;Duffy, P. E.
通讯作者：
Duffy, P. E.
影响因子：
3.3
作者：
Mathanga, Don P.;Campbell, Carl H.;Wilson, Mark L.
通讯作者：
Wilson, Mark L.
影响因子：
3.3
作者：
Nebie, I.;Tiono, A. B.;Sirima, B. S.
通讯作者：
Sirima, B. S.