The impact of vector control interventions on adverse birth outcomes.

项目总结 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(LBW)婴儿、22万死产和11万新生儿死亡。 病媒控制战略，包括长效驱虫蚊帐和室内残留 喷洒杀虫剂(IRS)是预防疟疾的强大公共卫生工具，然而，它们目前对 不良的分娩结局是未知的。建议所有疟疾流行的孕妇服用LLIN 非洲，但考虑到LLIN中使用的拟除虫菊酯类杀虫剂的广泛抗药性，它们的效力可能 正在消退。另一种蚊帐，拟除虫菊酯-PBO LLIN，在取代现有LLIN方面显示出希望。最近 模拟研究表明，拟除虫菊酯-PBO LLIN可能是非常有效的，有可能避免多达500 每1000人年临床疟疾病例与标准(即非PBO治疗)LLINs的比较6。评估 拟除虫菊酯-PBO LLIN可能对孕妇的公共健康影响，流行病学证据 需要对之前的建模研究结果进行补充。国税局是另一项重要的公共卫生战略 被证明在减轻疟疾负担方面非常有效7-12，但传统上没有得到充分利用 到高昂的成本。我们小组的探索性发现表明，IRS与LBW、早产的减少有关 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- 相关的不良分娩结果需要使用更严格的研究设计进行进一步评估。 这项提议的目标是调查当前和新的媒介控制的有效性。 预防疟疾相关不良生育结局的工具。乌干达将作为一个案例研究 此建议作为IRS、标准LLIN和拟除虫菊酯-PBO LLIN的最新社区分布提供了 这是研究这些效应的一个独特的准实验机会。这项研究将估计LBW和 由于IRS(目标1)和标准LLIN(目标2a)的直接结果，避免了新生儿死亡。这项研究还将 评估拟除虫菊酯-PBO LLIN是否比标准LLIN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和严格的当代因果关系 推理方法。该提案将提供宝贵和及时的见解，以了解现有的媒介控制是否 策略是否有效或是否应推荐新的LLIN用于以下孕妇 标准LLIN。从这项研究中获得的知识将直接推动NICHD识别 将减少全球围产期死亡的跨学科方法。拟议的培训由一个 模范指导团队，将提高申请者的方法技能、研究能力和 作为一名未来的独立学术研究员，她的职业生涯所需的内容专业知识专注于 在全球范围内改善妇幼保健。

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.