[阿比让孕妇中与疟疾预防相关的铁补充剂]

[Iron supplementation associated with malaria prevention among pregnant women in Abidjan].

作者信息

Carré N, Eono P, Kouakou K, Duponchel J-L, Marquis M, Zahui K H

机构信息

Projet PASSI, Service de Coopération et d'Action Culturelle, Ambassade de France, 01 BP 1839, 01 Abidjan, Côte d'Ivoire.

出版信息

Rev Epidemiol Sante Publique. 2003 Feb;51(1 Pt 1):31-8.

DOI:

PMID:12684579

Abstract

BACKGROUND

Despite the demonstrated efficacy of iron supplements and malaria prevention, the effectiveness of antenatal care programs for prevention of anaemia (haemoglobin rate<11 g/dL) in pregnant women is low in West Africa. Apart from the issue of availability and despite low cost, the major reason evoked is the lack of motivation of pregnant women and health care professionals. In this study, iron supplements and malaria prophylactics were provided free of charge during pregnancy. The treatment was proposed at the first antenatal visit, with the objective of not interfering with routine practice of birth attendants and women in latter antenatal visits.

METHODS

Haemoglobin rates were measured and Plasmodium falciparum tested for among pregnant women in four maternity units in Abidjan. The tests were carried out at inclusion during the first antenatal visit and during immediate post-partum in 631 pregnant women who delivered in one of the four wards. Considering the objective of the study, compliance was assessed for the month prior to delivery.

RESULTS

Despite an habitual decrease in iron deficiency at the end of pregnancy, haemoglobin rates in the study population increased from 10.4 g/dL at inclusion to 10.9 g/dL during post-partum. Prevalence of anemia consequently decreased from 62.8% to 49.4% (p<0.01). A similar increase of 0.7 g/dL was observed among women stating a regular (57%) or irregular (36.9%) compliance with the protocol. A decrease of 0.4 g/dL (s.t.: 1.8 g/dL) was observed among women stating a lack of compliance with the protocol (5.6%). The prevalence of anaemia according to compliance was consequently 43.1%, 49.7% and 70.1% (p=0.02). Severe anaemia (<8 g/dL) at inclusion was an independent risk factor for post-partum anaemia although a 2.9 g/dL increase (s.t.: 2.0 g/dL) was observed in the latter (p<0.01). However, the 11 g/dL threshold was not reached.

CONCLUSION

It is therefore important to reinforce the availability of treatments to prevent anaemia in pregnant women due to their demonstrated efficiency as a part of routine antenatal activities.

摘要

背景

尽管铁补充剂和疟疾预防措施已被证明有效，但在西非，产前保健项目预防孕妇贫血（血红蛋白水平<11 g/dL）的效果不佳。除了供应问题，尽管成本低廉，但主要原因是孕妇和医护人员缺乏积极性。在本研究中，孕期免费提供铁补充剂和疟疾预防药物。在首次产前检查时提出治疗方案，目的是不干扰接生人员和孕妇在后续产前检查中的常规做法。

方法

在阿比让的四个产科病房对孕妇进行血红蛋白水平测量和恶性疟原虫检测。对在四个病房之一分娩的631名孕妇在纳入研究时即首次产前检查时以及产后立即进行检测。考虑到研究目的，评估分娩前一个月的依从性。

结果

尽管孕期结束时缺铁情况通常会减少，但研究人群的血红蛋白水平从纳入时的10.4 g/dL升至产后的10.9 g/dL。贫血患病率因此从62.8%降至49.4%（p<0.01）。在表示定期（57%）或不定期（36.9%）遵守方案的女性中也观察到类似的0.7 g/dL的升高。在表示未遵守方案的女性中（5.6%）观察到下降0.4 g/dL（标准差：1.8 g/dL）。根据依从性得出的贫血患病率分别为43.1%、49.7%和70.1%（p=0.02）。纳入研究时的严重贫血（<8 g/dL）是产后贫血的独立危险因素，尽管后者观察到升高2.9 g/dL（标准差：2.0 g/dL）（p<0.01）。然而，未达到11 g/dL的阈值。