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

在印度尼西亚，约有10%的孕妇感染了疟疾。通过在印度尼西亚巴布亚进行的一项新研究，印度尼西亚对妊娠期疟疾的控制可能会得到潜在的推动。利物浦热带医学院（英国）和印度尼西亚巴布亚的Timika研究机构之间的一个伙伴关系将对一种有希望的基于药物的预防疟疾的新方案及其对怀孕的有害影响进行全面评估。当孕妇感染疟疾时，感染可对妊娠造成毁灭性后果，导致发烧，从而可能引发早产甚至流产。妇女也有可能在没有任何外在迹象或症状的情况下被感染，但如果这些感染未被发现和不加以治疗，就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、生长迟缓和在出生后第一年死亡。这项新的研究将支持印度尼西亚卫生部确定提供一种新的预防方案的最佳方式，这种方案被称为间歇预防治疗（IPT），用于控制怀孕期间的疟疾。IPT在非洲大多数国家使用，但在亚洲尚未使用。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保健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）的长效抗疟疾药物治疗，每次服药后可提供四周的预防。目前，妇女在第一次产前检查时接受疟疾筛查，只有检测呈阳性的妇女才接受DP治疗。在新的战略中，妇女将每月接受这种药物的预防，而无需事先进行疟疾寄生虫的血液检测。最近在印度尼西亚进行的一项试验表明，如果按照指示进行干预，这种干预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区域来说是新的。事实上，这将是第一次在东南亚使用IPT战略。这项研究的目的是为卫生部找到引进和实施这一新的干预措施的最佳途径，并采用逐步提高质量的方法，了解在实施阶段的每个步骤中，哪些措施、对谁有效以及为什么有效，以帮助不断改进新干预措施的实施和提供服务的质量。将加强通过保健站使干预措施接近社区的机会，因为大多数妇女在保健站接受产前护理。这项研究还将确定新战略与当前战略相比的成本和成本效益，从而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预防疟疾的效力，有可能增加提供和接受额外的产前保健服务，以防止怀孕期间不良分娩结果的其他原因。最后的研究结果将与印度尼西亚卫生部和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。因此，这项研究将有助于改善印度尼西亚母亲及其婴儿的成果，他们的生活质量、健康和创造性产出将得到提高。这将是一个32个月的研究，6个月的研究准备，22个月的实地工作，数据收集和数据处理，以及4个月的总结分析和报告。

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.