Wort Ulrika Uddenfeldt, Hastings Ian, Mutabingwa T K, Brabin Bernard J
Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
Malar J. 2006 Oct 17;5:89. doi: 10.1186/1475-2875-5-89.
The impact of malaria on the risk of stillbirth is still under debate. The aim of the present analysis was to determine comparative changes in stillbirth prevalence between two areas of Tanzania with different malaria transmission patterns in order to estimate the malaria attributable component.
A retrospective analysis was completed of stillbirth differences between primigravidae and multigravidae in relation to malaria cases and transmission patterns for two different areas of Tanzania with a focus on the effects of the El Niño southern climatic oscillation (ENSO). One area, Kagera, experiences outbreaks of malaria, and the other area, Morogoro, is holoendemic. Delivery and malaria data were collected over a six year period from records of the two district hospitals in these locations.
There was a significantly higher prevalence of low birthweight in primigravidae compared to multigravidae for both data sets. Low birthweight and stillbirth prevalence (17.5% and 4.8%) were significantly higher in Kilosa compared to Ndolage (11.9% and 2.4%). There was a significant difference in stillbirth prevalence between Ndolage and Kilosa between malaria seasons (2.4% and 5.6% respectively, p < 0.001) and during malaria seasons (1.9% and 5.9% respectively, p < 0.001). During ENSO there was no difference (4.1% and 4.9%, respectively). There was a significant difference in low birthweight prevalence between Ndolage and Kilosa between malaria seasons (14.4% and 23.0% respectively, p < 0.001) and in relation to malaria seasons (13.9% and 25.2% respectively, p < 0.001). During ENSO there was no difference (22.2% and 19.8%, respectively). Increased low birthweight risk occurred approximately five months following peak malaria prevalence, but stillbirth risk increased at the time of malaria peaks.
Malaria exposure during pregnancy has a delayed effect on birthweight outcomes, but a more acute effect on stillbirth risk.
疟疾对死产风险的影响仍存在争议。本分析的目的是确定坦桑尼亚两个疟疾传播模式不同的地区死产患病率的比较变化，以估计疟疾所致的部分。
对坦桑尼亚两个不同地区初产妇和经产妇的死产差异与疟疾病例及传播模式进行回顾性分析，重点关注厄尔尼诺南方涛动（ENSO）的影响。一个地区卡盖拉疟疾暴发，另一个地区莫罗戈罗为高度地方性流行区。通过这两个地区两家 district 医院六年期间的记录收集分娩和疟疾数据。
两个数据集的初产妇低出生体重患病率均显著高于经产妇。基洛萨的低出生体重和死产患病率（分别为 17.5%和 4.8%）显著高于恩多拉格（分别为 11.9%和 2.4%）。恩多拉格和基洛萨在非疟疾季节（分别为 2.4%和 5.6%，p < 0.001）和疟疾季节（分别为 1.9%和 5.9%，p < 0.001）的死产患病率存在显著差异。在 ENSO 期间无差异（分别为 4.1%和 4.9%）。恩多拉格和基洛萨在非疟疾季节（分别为 14.4%和 23.0%，p < 0.001）以及与疟疾季节相关（分别为 13.9%和 25.2%，p < 0.001）的低出生体重患病率存在显著差异。在 ENSO 期间无差异（分别为 22.2%和 19.8%）。低出生体重风险增加约在疟疾患病率高峰后五个月出现，但死产风险在疟疾高峰时增加。
孕期暴露于疟疾对出生体重结局有延迟影响，但对死产风险有更急性的影响。
