Guyatt H L, Noor A M, Ochola S A, Snow R W
Kenya Medical Research Institute/Wellcome Trust Collaborative Programme, Nairobi, Kenya.
Trop Med Int Health. 2004 Feb;9(2):255-61. doi: 10.1046/j.1365-3156.2003.01193.x.
The roll back malaria (RBM) movement promotes the use of insecticide-treated bednets (ITNs) and intermittent presumptive treatment (IPT) of malaria infection as preventive measures against the adverse effects of malaria among pregnant women in Africa. To determine the use of these preventive measures we undertook a community-based survey of recently pregnant women randomly selected from communities in four districts of Kenya in December 2001. Of the 1814 women surveyed, only 5% had slept under an ITN. More than half of the 13% of women using a bednet (treated or untreated) had bought their nets from shops or markets. Women from rural areas used bednets less than urban women (11% vs. 27%; P < 0.001), and 41% of the bednets used by rural women had been obtained free of charge from a research project in Bondo or a nationwide UNICEF donation through antenatal clinics (ANCs). Despite 96% of ANC providers being aware of IPT with sulphadoxine-pyrimethamine (SP), only 5% of women interviewed had received two or more doses of SP as a presumptive treatment. The coverage of pregnant women with at least one dose of IPT with SP was 14%, though a similar percentage also had received at least a single dose as a curative treatment. The coverage of nationally recommended strategies to prevent malaria during pregnancy during 2001 was low across the diverse malaria ecology of Kenya. Rapid expansion of access to these services is required to meet international and national targets by the year 2005. The scaling up of malaria prevention programmes through ANC services should be possible with 74% of women visiting ANCs at least twice in all four districts. Issues of commodity supply and service costs to clients will be the greatest impediments to reaching RBM targets.
抗击疟疾运动（RBM）提倡使用经杀虫剂处理的蚊帐（ITN）以及对疟疾感染进行间歇性推定治疗（IPT），以此作为预防非洲孕妇疟疾不良影响的措施。为确定这些预防措施的使用情况，我们于2001年12月在肯尼亚四个地区的社区中对近期怀孕的妇女进行了一项基于社区的随机调查。在接受调查的1814名妇女中，只有5%的人睡在经杀虫剂处理的蚊帐下。在使用蚊帐（无论是否经过处理）的13%的妇女中，超过一半是从商店或市场购买的蚊帐。农村地区的妇女使用蚊帐的比例低于城市妇女（11%对27%；P<0.001），农村妇女使用的蚊帐中有41%是通过邦多的一个研究项目或通过产前诊所（ANC）获得的联合国儿童基金会全国捐赠免费得到的。尽管96%的ANC服务提供者知晓使用周效磺胺-乙胺嘧啶（SP）进行间歇性推定治疗，但在接受采访的妇女中，只有5%的人接受过两剂或更多剂的SP作为推定治疗。至少接受一剂SP进行间歇性推定治疗的孕妇覆盖率为14%，不过同样比例的孕妇也接受过至少一剂作为治疗性治疗。在肯尼亚不同的疟疾生态环境中，2001年全国推荐的预防孕期疟疾策略的覆盖率很低。要在2005年实现国际和国家目标，需要迅速扩大这些服务的可及性。鉴于所有四个地区74%的妇女至少两次前往ANC就诊，通过ANC服务扩大疟疾预防项目应该是可行的。商品供应和服务成本对客户而言将是实现抗击疟疾运动目标的最大障碍。
