Gyapong John O, Chinbuah Margaret A, Gyapong Margaret
Health Research Unit, Ghana Health Service, Accra, Ghana.
Trop Med Int Health. 2003 Dec;8(12):1093-101. doi: 10.1046/j.1360-2276.2003.01142.x.
The current strategy for the interruption of transmission of lymphatic filariasis in areas where the disease is co-endemic with onchocerciasis is repeated annual mass treatment of endemic communities with ivermectin and albendazole. These drugs are not recommended for use in pregnancy. Pregnant women are excluded on the basis of their last menses. This exclusion criterion based on recall carries some inherent errors, leading sometimes to inadvertent exposure of foetuses to these drugs. This study set out to document the extent of inadvertent exposure of pregnant women to albendazole and ivermectin and assess the relative risk of congenital malformations because of inadvertent treatment with these drugs in early pregnancy. The study was conducted in the Ahanta West District of Ghana. Local pregnancy revelation norms were studied, followed by a household survey of women aged 15-45 years to assess drug administration coverage. All infants born within 42 weeks of the mass drug treatment were examined to document any congenital malformations. Mothers who had lost any such infants responded to a verbal autopsy to ascertain the probable cause of death. Health facilities and local Traditional Birth Attendants were also visited to review maternity records. Of 2985 women of childbearing age (15-49 years) who were interviewed, 343 were pregnant during the mass drug administration. The sensitivity of the last menstrual period in detecting pregnancy and thus being excluded from treatment was 0.854 (293 of 343). Some pregnant women 50 of 343 (14.6%) had thus been inadvertently treated. This represents 1.7% of women in fertile age group (15-49 years). Of the six children found with some congenital malformations in these communities, one had been exposed to the drugs in-utero. The relative risk for congenital malformation after exposure was 1.05 (P=1.0). Two of nine reported spontaneous abortions had been exposed to the drugs (P=0.62). We conclude that the local mode of excluding pregnancy in the current programme, while not perfect, is sufficiently effective and reliable for such a public health intervention; and importantly, that there is no evidence of a higher risk of congenital malformation or abortions in those who are inadvertently exposed.
在淋巴丝虫病与盘尾丝虫病共同流行的地区，目前用于阻断淋巴丝虫病传播的策略是每年对流行社区重复进行伊维菌素和阿苯达唑的群体治疗。这些药物不建议在孕期使用。孕妇是根据其末次月经来排除的。这种基于回忆的排除标准存在一些固有误差，有时会导致胎儿意外接触这些药物。本研究旨在记录孕妇意外接触阿苯达唑和伊维菌素的程度，并评估孕早期因意外接受这些药物治疗而导致先天性畸形的相对风险。该研究在加纳的阿汉塔西区开展。研究了当地的妊娠披露规范，随后对15至45岁的女性进行了家庭调查，以评估药物服用覆盖率。对在群体药物治疗后42周内出生的所有婴儿进行检查，以记录任何先天性畸形情况。失去此类婴儿的母亲接受了口头尸检，以确定可能的死亡原因。还走访了卫生设施和当地的传统助产士，以查阅产妇记录。在接受访谈的2985名育龄妇女（15至49岁）中，有343人在群体药物给药期间怀孕。末次月经用于检测妊娠并因此被排除在治疗之外的敏感度为0.854（343人中的293人）。因此，一些孕妇（343人中的50人，占14.6%）被意外治疗。这占育龄组（15至49岁）妇女的1.7%。在这些社区发现的6名有某些先天性畸形的儿童中，有1名在子宫内接触过这些药物。接触后先天性畸形的相对风险为1.05（P = 1.0）。报告的9例自然流产中有2例接触过这些药物（P = 0.62）。我们得出结论，当前项目中排除妊娠的当地方式虽然并不完美，但对于这样的公共卫生干预措施来说足够有效且可靠；重要的是，没有证据表明意外接触者出现先天性畸形或流产的风险更高。
