Mbonye Anthony K, Bygbjerg Ib, Magnussen Pascal
Reproductive Health Division, Department of Community Health, Ministry of Health, PO Box 7272, Kampala, Uganda.
Int J Infect Dis. 2008 Jan;12(1):22-9. doi: 10.1016/j.ijid.2006.10.008. Epub 2007 May 29.
The main objective of the study was to assess the impact of a community-based delivery system of intermittent preventive treatment (IPT) for malaria in pregnancy with sulfadoxine-pyrimethamine (SP) on access, parasitemia, anemia and low birth weight as primary outcome measures.
A study was designed to test the community-based delivery system of IPT through traditional birth attendants (TBAs), drug-shop vendors (DSVs), community reproductive health workers (CRHWs) and adolescent peer mobilizers (APMs), and to compare these with IPT at health units in an area of high malaria transmission - Mukono District, Uganda.
Two thousand seven hundred and eighty-five pregnant women participated in the study. The majority of the women (92.4%) at the community-based approaches received their first dose of IPT during their second trimester compared to 76.1% at health units (p<0.0001). At both health units and the community-based approaches, IPT increased mean hemoglobin by 6.7% (p<0.0001) for all parities and by 10.2% among primigravidae. IPT reduced the prevalence of severe anemia from 5.7% to 3.1% (p<0.04). The prevalence of parasitemia was reduced from 24.5% to 16.1% (p<0.001), and parasite density reduced significantly (p<0.02) after the first dose and remained stable with the second dose. Overall the proportion of low birth weight was 6.3% (8.3% at health units versus 6.0% at the community-based approaches, p<0.03) highlighting the importance of access and adherence to IPT. This intervention was acceptable to 89.6% of the women at the community-based approaches intending to use IPT in the future, while 48.1% of them had recommended it to other women.
The community-based approaches increased access and adherence to IPT with an effect on anemia, severe anemia, parasitemia and low birth weight. However the reduced effect of IPT on parasitemia points to drug resistance with SP and this requires further evaluation; research into the identification of other more efficacious drugs for malaria prevention in pregnancy is also required.
本研究的主要目的是评估基于社区的磺胺多辛-乙胺嘧啶（SP）间歇性预防治疗（IPT）疟疾分娩系统对获得治疗情况、寄生虫血症、贫血和低出生体重的影响，将这些作为主要结局指标。
设计一项研究，通过传统接生员（TBAs）、药店供应商（DSVs）、社区生殖健康工作者（CRHWs）和青少年同伴动员者（APMs）来测试基于社区的IPT分娩系统，并将其与乌干达疟疾高传播地区穆科诺区卫生单位的IPT进行比较。
2785名孕妇参与了该研究。采用基于社区方法的大多数妇女（92.4%）在孕中期接受了第一剂IPT，而卫生单位的这一比例为76.1%（p<0.0001）。在卫生单位和基于社区的方法中，IPT使所有孕周的平均血红蛋白水平提高了6.7%（p<0.0001），初产妇中提高了10.2%。IPT将严重贫血的患病率从5.7%降至3.1%（p<0.04）。寄生虫血症的患病率从24.5%降至16.1%（p<0.001），首次服药后寄生虫密度显著降低（p<0.02），第二次服药后保持稳定。总体而言，低出生体重的比例为6.3%（卫生单位为8.3%，基于社区的方法为6.0%，p<0.03），突出了获得治疗和坚持IPT的重要性。在基于社区方法中，89.6%打算未来使用IPT的妇女接受了这种干预，其中48.1%的妇女已向其他妇女推荐了该干预措施。
基于社区的方法增加了获得IPT的机会和依从性，对贫血、严重贫血、寄生虫血症和低出生体重产生了影响。然而，IPT对寄生虫血症的效果降低表明对SP存在耐药性，这需要进一步评估；还需要开展研究以确定其他更有效的孕期疟疾预防药物。
