The impact of vector control interventions on adverse birth outcomes.

病媒控制干预措施对不良出生结局的影响。

• 批准号: 9900569
• 负责人: Michelle Roh
• 金额: $ 3.86万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9900569
• 关键词: Africa; Africa South of the Sahara; Area; Beds; Biometry; Birth; Case Study; Clinical; Cluster randomized trial; Communities; Competence; Control Groups; Country; Data; Effectiveness; Epidemiology; Evaluation; Future; Goals; Health; Infection; Insecticides; Interruption; Intervention; Investigation; Knowledge; Low Birth Weight Infant; Low Prevalence; Malaria; Malaria prevention; Maternal and Child Health; Mentorship; Methodology; Methods; Mission; Morbidity - disease rate; National Institute of Child Health and Human Development; Neonatal; Neonatal Mortality; Outcome; Parasites; Perinatal; Perinatal mortality demographics; Persons; Policies; Policy Maker; Pregnancy; Pregnant Women; Premature Birth; Public Health; Research; Research Design; Research Personnel; Residual state; Resistance; Risk; Sample Size; Study models; Time; Time Series Analysis; Training; Uganda; Universal Coverage; Woman; World Health Organization; base; career; cost; experimental study; fetal; global health; improved; insight; interdisciplinary approach; neonatal death; prevent; pyrethroid; scale up; skills; stillbirth; surveillance data; tool; vector; vector control

PROJECT SUMMARY In sub-Saharan Africa, infection with malaria parasites during pregnancy is estimated to be the cause of nearly 1 million low birth weight (LBW) babies, 220,000 stillbirths, and 110,000 neonatal deaths every year1-5. Vector control strategies, including long-lasting insecticide-treated bed nets (LLINs) and indoor residual spraying of insecticide (IRS) are powerful public health tools for malaria prevention, yet, their current impact on adverse birth outcomes is unknown. LLINs are recommended for all pregnant women in malaria-endemic Africa, but given widespread resistance to the pyrethroid class of insecticide used in LLINs, their efficacy may be waning. An alternative bed net, a pyrethroid-PBO LLIN, shows promise in replacing current LLINs. A recent modeling study showed pyrethroid-PBO LLINs may be highly effective, with the potential to avert up to 500 clinical malaria cases per 1000 person-years compared to standard (i.e. non PBO-treated) LLINs6. To evaluate the public health impact that pyrethroid-PBO LLINs may have for pregnant mothers, epidemiological evidence is needed to augment previous findings from modeling studies. IRS is another important public health strategy shown to be highly effective at reducing the burden of malaria7-12, but has traditionally been under-utilized due to high costs. Exploratory findings from our group suggest IRS is associated with reductions in LBW, preterm birth, and fetal/neonatal death13,14. However, whether IRS is an effective method of preventing malaria- associated adverse birth outcomes requires further evaluation using a more rigorous study design. The goal of this proposal is to investigate the effectiveness of current and new vector-control tools for preventing malaria-associated adverse birth outcomes. Uganda will be used as a case study for this proposal as the recent community distribution of IRS, standard LLINs, and pyrethroid-PBO LLINs provides a unique quasi-experimental opportunity to study these effects. The study will estimate the number of LBW and newborn deaths averted as a direct result of IRS (Aim 1) and standard LLINs (Aim 2a). The study will also assess whether pyrethroid-PBO LLINs confer a greater protective benefit than standard LLINs (Aim 2b). Analyses will use existing data, routinely collected by the Ministry of Health, and rigorous contemporary causal inference methods. The proposal will provide valuable and timely insight on whether existing vector-control strategies are effective or whether new LLINs to should be recommended for use in pregnant women over standard LLINs. Knowledge gained from this research will directly advance the NICHD’s mission of identifying interdisciplinary approaches that will reduce global perinatal deaths. The proposed training, guided by an exemplary mentorship team, will enhance the applicant’s methodological skills, research competency, and content expertise needed for her career as a future independent academic researcher focused on strategies to improve maternal and child health globally.

项目摘要 在撒哈拉以南非洲，怀孕期间感染疟疾寄生虫估计是导致 每年有近100万低出生体重婴儿、220，000例死产和110，000例新生儿死亡1 -5。 病媒控制战略，包括长效驱虫蚊帐和室内残留杀虫剂 喷洒杀虫剂（IRS）是预防疟疾的有力公共卫生工具，但其目前对 不良的生育结果是未知的。建议疟疾流行地区的所有孕妇使用长效驱虫蚊帐 非洲，但由于对长效驱虫蚊帐中使用的拟除虫菊酯类杀虫剂普遍存在抗药性， 变弱。一种替代蚊帐，即拟除虫菊酯-PBO长效蚊帐，有望取代目前的长效蚊帐。最近的一 模拟研究表明，拟除虫菊酯-PBO长效杀虫剂可能非常有效，有可能避免高达500 与标准（即未经PBO治疗）长效驱虫蚊帐相比，每1000人年的临床疟疾病例数6。评价 拟除虫菊酯-PBO长效驱虫蚊帐可能对孕妇产生公共卫生影响，流行病学证据 是需要从建模研究中增加以前的发现。IRS是另一项重要的公共卫生战略 在减少疟疾负担方面非常有效7 -12，但由于 高成本。我们小组的探索性发现表明，IRS与LBW、早产、 出生和胎儿/新生儿死亡13，14。然而，IRS是否是预防疟疾的有效方法- 相关的不良出生结局需要使用更严格的研究设计进行进一步评估。 本提案的目的是调查当前和新的矢量控制的有效性 预防与疟疾有关的不良分娩结果的工具。乌干达将作为一个案例研究， 这一建议，作为IRS、标准长效杀虫剂和拟除虫菊酯-PBO长效杀虫剂的最新社区分布，提供了 一个独特的准实验性的机会来研究这些影响。这项研究将估计低出生体重儿的人数， IRS（目标1）和标准长效驱虫蚊帐（目标2a）的直接结果避免了新生儿死亡。该研究还将 评估拟除虫菊酯-PBO长效驱虫蚊帐是否比标准长效驱虫蚊帐具有更大的保护效益（目标2b）。 分析将使用卫生部常规收集的现有数据，以及严格的当代因果关系。 推理方法该提案将提供有价值的和及时的见解，现有的矢量控制是否 策略是否有效，或者是否应推荐新的长效避孕药用于超过 标准LLIN。从这项研究中获得的知识将直接推动NICHD的使命， 采取跨学科方法，减少全球围产期死亡。拟议的培训，由一个 模范导师团队，将提高申请人的方法技能，研究能力， 内容专业知识需要她的职业生涯作为一个未来的独立学术研究人员专注于战略， 改善全球孕产妇和儿童健康。