Intermittent preventive treatment with dihydroartemisinin-piperaquine: a new malaria strategy to prevent adverse birth outcomes in Papua, Indonesia

减少印度尼西亚孕期疟疾的不良后果印度尼西亚大约10%的孕妇感染疟疾，通过印度尼西亚巴布亚的一项新研究，印度尼西亚对孕期疟疾的控制可能会得到潜在的促进。利物浦热带医学院(英国)和印度尼西亚蒂米卡研究机构之间的合作伙伴关系将对一种有前景的基于药物的预防疟疾的新药疗法及其怀孕期间的有害影响进行全面评估。当孕妇感染疟疾时，这种感染可能对怀孕造成毁灭性的后果，导致发烧，从而可能引发早产甚至流产。女性也有可能在没有任何外在迹象或症状的情况下被感染，但如果这些感染没有被发现和治疗，它们可能会导致母亲严重贫血，并可能干扰胎儿的生长，导致出生体重过低，从而使婴儿更容易受到感染，生长迟缓，并在出生第一年死亡。新的研究将支持印尼卫生部确定提供一种新的预防方案的最佳方式，以控制怀孕期间的疟疾，称为间歇预防治疗，简称IPT。IPT在非洲的大多数国家都在使用，但在亚洲还没有。通过这一IPT战略，在印度尼西亚巴布亚选定的卫生机构接受常规产前护理的无疟疾症状的孕妇将每月接受一种名为双氢青蒿素-哌喹(DP)的长效抗疟疾药物的治疗，该药物在每次服药后提供四周的预防。目前，妇女在第一次产前检查时接受疟疾筛查，只有在检测呈阳性的情况下才接受DP治疗。在新的战略中，妇女将每月接受药物预防，而无需事先进行疟疾寄生虫的血液测试。印度尼西亚最近的一项试验表明，如果按照指示采取这种干预措施，在预防孕妇疟疾方面非常有效。然而，没有疟疾症状的妇女使用药物进行预防的概念对该地区来说是新的。事实上，这将是第一次在东南亚使用知识产权战略。这项研究旨在为卫生部找到引入和提供这一新干预措施的最佳方法，并使用逐步质量改进方法来了解在实施阶段的每个步骤中，什么对谁有效，为什么，以帮助不断改进新干预措施的提供和服务质量。将加强通过大多数妇女接受产前护理的保健站使干预措施接近社区的机会。这项研究还将确定新战略与现行战略相比的成本和成本效益，以便为印度尼西亚孕妇预防疟疾的政策决策提供信息。这也将与东南亚其他地区有关。预计这项研究通过提高疟疾预防的有效性，有可能增加提供和吸收更多的非国大服务，以防止孕期不良生育结局的其他原因。最后的研究结果将与印度尼西亚卫生部、国家疟疾和生殖健康部门的地方办事处分享，以便为推出该战略的决策提供信息。这项研究将有助于改善印度尼西亚母婴的生活质量、健康和创造性产出，这将是一项为期32个月的研究，其中6个月用于研究准备，22个月用于实地工作，数据收集和数据处理，以及4个月用于总结分析和报告。

Reducing the adverse outcomes of malaria in pregnancy in IndonesiaThe control of malaria in pregnancy in Indonesia, where approximately 10% of pregnant women get infected with malaria, could receive a potential boost through a new study in Papua, Indonesia. A partnership between the Liverpool School of Tropical Medicine (UK) and the Timika Research Facility in Papua Indonesia will conduct a holistic evaluation of a promising new drug-based regimen for preventing malaria and its harmful effects in pregnancy. When pregnant women contract malaria, the infection can have devastating consequences for pregnancy, resulting in fever which may trigger the preterm onset of labour or even pregnancy loss. It is also possible for women to be infected without showing any outward signs or symptoms, yet if these infections are undetected and left untreated, they can cause severe anaemia in the mother and can interfere with the growth of the fetus leading to low birth weight, which makes babies more vulnerable to infections, growth retardation and dying during the first year of life.The new study will support the Indonesian Ministry of Health to identify the best way to deliver a new preventive regimen for the control of malaria in pregnancy called intermittent preventive treatment or IPT for short. IPT is used in most countries in Africa but not yet in Asia. With this IPT strategy, pregnant women without symptoms of malaria attending routine antenatal care in selected health facilities in Papua, Indonesia, will receive monthly treatment with a long-acting antimalarial drug called dihydroartemisinin-piperaquine (DP) that provides four weeks of prophylaxis after each dose. Currently women are screened for malaria at their first antenatal care visit and women are treated with DP only if tested positive. In the new strategy, women will receive the drug as monthly prophylaxis without prior blood testing for malaria parasites. A recent trial in Indonesia has shown that this intervention, when taken as directed, is very effective in preventing malaria in expectant mothers. However, the concept of using drugs for prevention by women who do not have malaria symptoms is new to this region. Indeed, this would be the first time that the IPT strategy would be used in South East Asia. The study is designed to find the best ways for the Ministry of Health to introduce and deliver this new intervention and use stepwise quality improvement approaches to understand what worked, for whom, and why during each step in the implementation phase to help improve delivery of the new intervention and quality of service provision on an ongoing basis. Opportunities to bring the intervention close to the community through health posts where most women receive antenatal care will be strengthened. The study will also determine the costs and cost-effectiveness of the new strategy, compared with the current strategy, to inform policy decision making for malaria prevention among pregnant women in Indonesia. This will also be of relevance to other parts of South East Asia. It is anticipated that the study, by increasing the effectiveness of malaria prevention, has the potential to increase the provision and uptake of additional ANC services that prevent other causes of adverse birth outcomes in pregnancy. The final study results will be shared with the local offices of the Ministry of Health and the National malaria, and reproductive health departments in Indonesia to inform policy decision making for rolling out the strategy. The study will thereby contribute to improved outcomes for mothers and their infants in Indonesia, whose quality of life, health and creative output will be enhanced.This will be a 32-month study, six months for study preparation, 22 months field work, data collection and data processing, and four months to conclude analysis and reporting.