在塞内加尔农村地区的一个区级卫生中心实施孕期用周效磺胺/乙胺嘧啶进行间歇性预防治疗（IPTp-SP）。

Implementation of intermittent preventive treatment in pregnancy with sulphadoxine/pyrimethamine (IPTp-SP) at a district health centre in rural Senegal.

作者信息

Olliaro Piero L, Delenne Henriette, Cisse Moustafa, Badiane Malick, Olliaro Alberto, Vaillant Michel, Brasseur Philippe

机构信息

UNICEF/UNDP/WB/WHO Special Programme for Research and Training in Tropical Diseases (TDR), 20 avenue Appia, CH-1211 Geneva 27, Switzerland.

出版信息

Malar J. 2008 Nov 7;7:234. doi: 10.1186/1475-2875-7-234.

BACKGROUND

Intermittent preventive treatment with sulphadoxine-pyrimethamine (SP) is recommended for reducing the risk of malaria in pregnancy and its consequences on mothers and babies (IPTp-SP). Indicators of implementation and effects of IPTp-SP were collected in a rural clinic in Southern Senegal.

METHODS

Women seen routinely at the antenatal clinic (ANC) of a rural dispensary during 2000-2007. Deployment of IPTp-SP started in January 2004. Inspection of antenatal and outpatient clinic registries of the corresponding period.

RESULTS

Between 1st January 2000 and 30th April 2007, 1,781 women of all gravitidities and parities attended the ANC with 965 deliveries (606 and 398 respectively since 1st January 2004, when IPTp-SP was started.) 69% of women were seen > or = 3 times; 95% received at least one dose and 70% two doses of SP (from 61% in 2004 to 86% in 2007). The first visit, first and second dose of SP occurred at a median week 20, 22 and 31. The probability of receiving two doses was > 80% with > or = 3 antenatal visits and a first dose of SP by week 20.The prevalence of maternal malaria was low and similar pre- (0.7%) and during IPTp (0.8%). Effects on of low birth weight (LBW, < 2.5 kg) were non-statistically significant. The prevalence of LBW was 10.8% pre- and 7.7% during IPTp deployment (29% risk reduction, p = 0.12).Unfavourable pregnancy outcomes numbered 72 (7.5% of pregnancies with known outcome), including 30 abortions and 42 later deaths (late foetal deaths, stillbirth, peri-natal) of which 13 with one or more malformations (1.35% of all recorded deliveries).

CONCLUSION

The implementation of IPTp-SP was high. Early attendance to ANC favours completion of IPTp-SP. The record keeping system in place is amenable to data extraction and linkage. A model was developed that predicts optimal compliance to two SP doses, and could be tested in other settings. Maternal malaria was infrequent and unaffected by IPTp-SP. The risk of LBW was lower during IPT implementation but the difference was non-significant and could have other explanations.

背景

推荐使用周效磺胺-乙胺嘧啶（SP）进行间歇性预防治疗，以降低妊娠疟疾风险及其对母婴的影响（IPTp-SP）。在塞内加尔南部的一家农村诊所收集了IPTp-SP的实施指标和效果。

方法

2000 - 2007年期间在一家农村药房的产前诊所（ANC）定期就诊的妇女。IPTp-SP的推广于2004年1月开始。检查同期的产前和门诊登记记录。

结果

在2000年1月1日至2007年4月30日期间，1781名不同孕周和产次的妇女到ANC就诊，其中965例分娩（自2004年1月1日IPTp-SP开始后分别为606例和398例）。69%的妇女就诊次数≥3次；95%的妇女接受了至少一剂SP，70%的妇女接受了两剂SP（从2004年的61%升至2007年的86%）。首次就诊、首次和第二次服用SP的中位孕周分别为20周、22周和31周。在产前检查≥3次且在20周前服用了第一剂SP的情况下，接受两剂SP的概率>80%。孕产妇疟疾的患病率较低，IPTp实施前（0.7%）和实施期间（0.8%）相似。对低出生体重（LBW，<2.5kg）的影响无统计学意义。IPTp实施前LBW的患病率为10.8%，实施期间为7.7%（降低风险29%，p = 0.12）。不良妊娠结局有72例（占已知结局妊娠的7.5%），包括30例流产和42例后期死亡（死胎、死产、围产期死亡），其中13例有一个或多个畸形（占所有记录分娩的1.35%）。