Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study.
Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study.
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DOI：
10.1371/journal.pone.0275370
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Titanji, Vincent P K
中科院分区：
文献类型：
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作者：
Apinjoh, Tobias O;Ntui, Vincent N;Chi, Hanesh F;Moyeh, Marcel N;Toussi, Cabrel T;Mayaba, Joel M;Tangi, Livinus N;Kwi, Pilate N;Anchang-Kimbi, Judith K;Dionne-Odom, Jodie;Tita, Alan T N;Achidi, Eric A;Amambua-Ngwa, Alfred;Titanji, Vincent P K
非洲目前的孕期疟疾预防和控制指南基于通过孕期间歇性预防治疗（IPTp）、经杀虫剂处理的蚊帐（ITNs）以及有效的疟疾病例诊断和管理来预防感染和/或疾病。由于担心撒哈拉以南非洲一些地区对磺胺多辛 - 乙胺嘧啶（SP）的耐药性增加可能会影响IPTp - SP的疗效，从而促使开展了这项同期研究，旨在评估喀麦隆西南大区一个快速发展的半城市地区穆滕盖内低传播季节分娩妇女亚微观感染的患病率和危险因素。在旱季最初前来建立产前诊所护理的孕妇被随访至足月，并记录其妊娠结局。使用恶性疟原虫富组氨酸蛋白2/乳酸脱氢酶（PfHRP2/pLDH）疟疾快速诊断试剂盒和光学显微镜采集约2毫升静脉血用于疟疾诊断。通过Chelex - 100方法从干血斑中提取DNA，并使用预先设计的特异性引物通过18S rRNA基因的巢式PCR扩增检测恶性疟原虫感染状况。在纳入的300名妇女中，通过显微镜、快速诊断检测（RDT）和PCR确定的疟原虫感染比例分别为12.9%、16.4%和29.4%，通过显微镜和/或RDT和/或PCR检测总体有39.9%感染恶性疟原虫，且为极低密度感染，平均每微升血液有271个疟原虫。约25.0%（68/272）显微镜检测为阴性的妇女PCR检测为阳性（亚微观恶性疟原虫感染），初产妇和未使用IPTp - SP被确定为亚微观恶性疟原虫血症的独立危险因素，而发热病史（调整优势比 = 4.83，95%置信区间 = 1.28 - 18.22，p = 0.020）与总体疟原虫感染风险相关。IPTp - SP的使用（p = 0.007）和剂量（p = 0.005）显著影响参与者是否疟原虫阴性或携带亚微观或微观感染。尽管婴儿出生体重和阿普加评分与母亲的恶性疟原虫感染及亚微观状态无关，但婴儿出生体重随母亲的孕次状态（p = 0.001）而变化，初产妇所生新生儿的出生体重明显低于经产妇（p = 0.001）和多产妇（p = 0.003）。即使在高流行的旱季，也有很大比例的孕妇存在极低密度的疟原虫血症。IPTp - SP似乎在控制亚微观恶性疟原虫感染方面是相关的，这种感染在孕妇中仍然很常见，且难以诊断，对母婴健康可能有有害影响。未来应在疟原虫血症水平明显更高的超高疟疾流行区进行研究，以确认IPTp - SP的疗效。
The current guidelines for malaria prevention and control during pregnancy in Africa is predicated on the prevention of infection and/or disease through intermittent preventive treatment in pregnancy (IPTp), insecticide-treated nets (ITNs) and effective malaria case diagnosis and management. Concerns that increasing SP resistance in some areas of SSA may have compromised IPTp-SP efficacy prompted this contemporaneous study, designed to assess the prevalence and risk factors of sub-microscopic infection in parturient women during the low transmission season in Mutengene, a rapidly growing semi-urban area in Southwest Region, Cameroon. Pregnant women originally reporting for the establishment of antenatal clinic care during the dry season were followed-up to term and their pregnancy outcomes recorded. About 2 ml of venous blood was collected for malaria diagnosis using PfHRP2/pLDH malaria rapid diagnostic kit and light microscopy. DNA was extracted from dried blood spots by the Chelex-100 method and the Plasmodium falciparum status detected by nested PCR amplification of the 18SrRNA gene using specific predesigned primers. Of the 300 women enrolled, the proportion of malaria parasite infected as determined by microscopy, RDT and PCR was 12.9%, 16.4% and 29.4% respectively, with 39.9% overall infected with P. falciparum by microscopy and/or RDT and/or PCR and a very low-density infection, averaging 271 parasites per microliter of blood. About 25.0% (68/272) of women who were negative by microscopy were positive by PCR (submicroscopic P. falciparum infection), with primigravidae and IPTp-SP non usage identified as independent risk factors for submicroscopic P. falciparum parasitaemia while fever history (aOR = 4.83, 95% CI = 1.28–18.22, p = 0.020) was associated with risk of malaria parasite infection overall. IPTp-SP use (p = 0.007) and dosage (p = 0.005) significantly influenced whether or not the participant will be malaria parasite negative or carry submicroscopic or microscopic infection. Although Infant birthweight and APGAR score were independent of the mother’s P. falciparum infection and submicroscopic status, infant’s birthweight varied with the gravidity status (p = 0.001) of the mother, with significantly lower birthweight neonates born to primigravidae compared to secundigravidae (p = 0.001) and multigravidae (p = 0.003). Even in holo-endemic dry season, there exists a large proportion of pregnant women with very low density parasitaemia. IPTp-SP seems to be relevant in controlling submicroscopic P. falciparum infections, which remains common in pregnant women, and are hard to diagnose, with potentially deleterious consequences for maternal and fetal health. Future studies should be carried out in hyperendemic malaria foci where the parasitemia levels are substantially higher in order to confirm the efficacy of IPTp-SP.