ter Kuile Feiko O, Terlouw Dianne J, Phillips-Howard Penelope A, Hawley William A, Friedman Jennifer F, Kariuki Simon K, Shi Ya Ping, Kolczak Margarette S, Lal Altaf A, Vulule John M, Nahlen Bernard L
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Am J Trop Med Hyg. 2003 Apr;68(4 Suppl):50-60.
The impact of insecticide (permethrin)-treated bed nets (ITNs) on malaria in pregnancy was studied in a rural area in western Kenya with intense perennial malaria transmission. All households in 40 of 79 villages were randomized to receive ITNs by January 1997. The ITNs were distributed in control villages two years later. Complete data on birth outcome were available on 2,754 (89.6%) of 3,072 deliveries. Women (n = 780) were followed monthly throughout pregnancy in 19 of 79 villages. Among gravidae 1-4, ITNs were associated with reductions of 38% (95% confidence interval [CI] = 17-54%) in the incidence of malaria parasitemia and 47% (95% CI = 6-71%) in the incidence of severe malarial anemia (hemoglobin level < 8 g/dL with parasitemia) during pregnancy. At the time of delivery, mean hemoglobin levels were 0.6 g/dL (95% CI = 0.01-1.2 g/dL) higher, the prevalence of placental or maternal malaria was reduced by 35% (95% CI = 20-47%), and the prevalence of low birth weight was reduced by 28% (95% CI = 2-47%) in gravidae 1-4 from ITN villages. No beneficial impact was observed in gravidae five or higher. In areas of intense perennial malaria transmission, permethrin-treated bed nets reduce the adverse effect of malaria during the first four pregnancies.
在肯尼亚西部一个常年疟疾传播严重的农村地区，研究了用杀虫剂（氯菊酯）处理过的蚊帐（ITN）对妊娠疟疾的影响。1997年1月前，79个村庄中40个村庄的所有家庭被随机分配接受ITN。两年后，在对照村庄分发了ITN。3072例分娩中有2754例（89.6%）获得了完整的出生结局数据。在79个村庄中的19个村庄，对780名妇女在整个孕期每月进行随访。在初孕至四孕的孕妇中，ITN与孕期疟疾寄生虫血症发病率降低38%（95%置信区间[CI]=17 - 54%）以及严重疟疾贫血（血红蛋白水平<8 g/dL且伴有寄生虫血症）发病率降低47%（95% CI = 6 - 71%）相关。分娩时，来自使用ITN村庄的初孕至四孕孕妇的平均血红蛋白水平高0.6 g/dL（95% CI = 0.01 - 1.2 g/dL），胎盘或母体疟疾患病率降低35%（95% CI = 20 - 47%），低出生体重患病率降低28%（95% CI = 2 - 47%）。在五孕及以上孕妇中未观察到有益影响。在常年疟疾传播严重的地区，氯菊酯处理过的蚊帐可降低前四次妊娠期间疟疾的不良影响。
