van Geertruyden Jean-Pierre, Thomas Florence, Erhart Annette, D'Alessandro Umberto
Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.
Am J Trop Med Hyg. 2004 Aug;71(2 Suppl):35-40.
The link between malaria and perinatal mortality was explored by systematically reviewing 117 studies published between 1948 and 2002. The mean perinatal mortality rate was higher in malaria endemic countries (61.1/1,000, 95% confidence interval [CI] = 52.1-70.1) than in non-endemic countries (25.8/1,000, 95% CI = 21.1-30.6). Similarly, the fetal mortality rate was higher in endemic countries (40.1/1,000, 95% CI = 32.1-48.0) than in non-endemic countries (20.0/1,000, 95% CI = 13.2-26.8) countries. Considering that perinatal mortality is an important indicator of obstetric care quality and socioeconomic development, further analysis was restricted to countries with a human development index between 500 and 800. In this category, the perinatal mortality rate was also significantly higher in endemic countries (50.5/1,000, 95% CI = 35.5-65.5) than in non-endemic countries (30.0/1,000, 95% CI = 25.7-34.3). In some publications, the occurrence of placental malaria and stillbirth was available. Placental malaria was significantly associated with a higher risk for stillbirth, regardless of parity (odds ratio = 2.19, 95% CI = 1.49-3.22, P < 0.001). Despite the limitations involved in this kind of review, all information found indicates that in endemic countries, malaria is an important determinant of perinatal mortality. Preventive measures such as intermittent preventive treatment or insecticide-treated bed nets could substantially reduce perinatal mortality and fetal wastage.
通过系统回顾1948年至2002年间发表的117项研究，探讨了疟疾与围产期死亡率之间的联系。疟疾流行国家的平均围产期死亡率（61.1/1000，95%置信区间[CI]=52.1-70.1）高于非流行国家（25.8/1000，95%CI=21.1-30.6）。同样，流行国家的胎儿死亡率（40.1/1000，95%CI=32.1-48.0）高于非流行国家（20.0/1000，95%CI=13.2-26.8）。鉴于围产期死亡率是产科护理质量和社会经济发展的重要指标，进一步分析仅限于人类发展指数在500至800之间的国家。在这一类别中，流行国家的围产期死亡率（50.5/1000，95%CI=35.5-65.5）也显著高于非流行国家（30.0/1000，95%CI=25.7-34.3）。在一些出版物中，有胎盘疟疾和死产发生率的数据。无论产次如何，胎盘疟疾与死产风险较高显著相关（优势比=2.19，95%CI=1.49-3.22，P<0.001）。尽管此类综述存在局限性，但所有发现的信息表明，在流行国家，疟疾是围产期死亡率的重要决定因素。间歇性预防治疗或经杀虫剂处理的蚊帐等预防措施可大幅降低围产期死亡率和胎儿死亡。
