Saute Francisco, Menendez Clara, Mayor Alfredo, Aponte John, Gomez-Olive Xavier, Dgedge Martinho, Alonso Pedro
Centro de Investigação em Saúde da Manhiça, Instituto Nacional de Saúde, Maputo, Mozambique.
Trop Med Int Health. 2002 Jan;7(1):19-28. doi: 10.1046/j.1365-3156.2002.00831.x.
Falciparum malaria affects pregnant women, especially primigravidae, but before malaria control programmes targeted to them can be designed, a description of the frequency and parity pattern of the infection is needed. There is little information on the frequency and effect of submicroscopic malaria infection, as well as on multiplicity of Plasmodium falciparum genotypes in pregnancy. This study aimed to describe the prevalence of malaria parasitaemia and anaemia and their relation to parity and age in pregnant women, during two malaria transmission seasons in a rural area of southern Mozambique. It also tried to assess the frequency and effect on anaemia of submicroscopic and multiple falciparum infections.
A total of 686 pregnant women were enrolled in three cross-sectional community-based surveys during different transmission seasons in rural southern Mozambique. In each survey a questionnaire was administered on previous parity history, the gestational age was assessed, the axillary temperature recorded and both haematocrit and malaria parasitaemia were determined. We used polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis to determine submicroscopic and multiple P. falciparum infections in a subsample of women.
A total of 156 women (23%) had microscopic parasitaemia, of which 144 (92%) were asexual forms of P. falciparum. The prevalence of clinical malaria was 18 of 534 (3%), that of anaemia, 382 of 649 (59%). In a multivariate analysis age but not parity was associated with an increased risk of microscopic parasitaemia. Anaemia was associated with microscopic P. falciparum parasitaemia. Both malaria parasitaemia and anaemia were more frequent during the rainy season. Although not statistically significant, submicroscopic infections tended to be more frequent among grand-multiparous pregnant women. Subpatent infections were not associated with increased anaemia. Multiplicity of infection was not associated with either parity, age or anaemia. Likewise, there was no correlation between P. falciparum density and multiplicity of infection.
We did not observe a clear parity pattern of malaria and anaemia in our study. It is possible although unlikely that selection bias may have influenced these findings; but in which direction is unclear. The importance of locally based research before implementation of public health measures needs to be highlighted. According to our findings, a more cost-effective malaria control approach in this area would be targeting all pregnant women regardless of their parity. This would be also more feasible logistically as it would not rely on accurate ascertainment of parity, something that is not always easy in busy antenatal clinics.
恶性疟影响孕妇，尤其是初产妇，但在制定针对她们的疟疾控制规划之前，需要了解感染的频率和胎次模式。关于亚显微疟原虫感染的频率和影响，以及孕期恶性疟原虫基因型的多样性，目前所知甚少。本研究旨在描述莫桑比克南部农村地区两个疟疾传播季节中，孕妇疟疾寄生虫血症和贫血的患病率及其与胎次和年龄的关系。研究还试图评估亚显微和多重恶性疟感染的频率及其对贫血的影响。
在莫桑比克南部农村不同传播季节的三次基于社区的横断面调查中，共纳入686名孕妇。每次调查均发放一份关于既往胎次史的问卷，评估孕周，记录腋窝温度，并测定血细胞比容和疟疾寄生虫血症。我们使用聚合酶链反应（PCR）和限制性片段长度多态性（RFLP）分析，来确定部分女性样本中亚显微和多重恶性疟感染情况。
共有156名女性（23%）存在显微镜下可检测到的寄生虫血症，其中144名（92%）为恶性疟原虫的无性体。临床疟疾的患病率为534例中的18例（3%），贫血的患病率为649例中的382例（59%）。在多变量分析中，年龄而非胎次与显微镜下可检测到的寄生虫血症风险增加相关。贫血与显微镜下恶性疟原虫寄生虫血症相关。疟疾寄生虫血症和贫血在雨季更为常见。尽管无统计学意义，但亚显微感染在多胎经产妇中似乎更为常见。亚临床感染与贫血增加无关。感染多样性与胎次、年龄或贫血均无关。同样，恶性疟原虫密度与感染多样性之间也无相关性。
在我们的研究中，未观察到疟疾和贫血的明显胎次模式。虽然可能性不大，但选择偏倚可能影响了这些结果；但具体方向尚不清楚。需要强调在实施公共卫生措施之前进行基于当地研究的重要性。根据我们的研究结果，该地区更具成本效益的疟疾控制方法是针对所有孕妇，无论其胎次如何。这在后勤方面也更可行，因为它不依赖于准确确定胎次，而在繁忙的产前诊所中，这并非总是容易做到的。
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