Msyamboza K P, Savage E J, Kazembe P N, Gies S, Kalanda G, D'Alessandro U, Brabin B J
Malaria Alert Centre, College of Medicine, Blantyre, Malawi.
Trop Med Int Health. 2009 Feb;14(2):183-9. doi: 10.1111/j.1365-3156.2008.02197.x. Epub 2009 Jan 15.
To evaluate the impact of a 2-year programme for community-based delivery of sulfadoxine-pyrimethamine (SP) on intermittent preventive treatment during pregnancy coverage, antenatal clinic attendance and pregnancy outcome.
Fourteen intervention and 12 control villages in the catchment areas of Chikwawa and Ngabu Government Hospitals, southern Malawi, were selected. Village-based community health workers were trained in information, education and counselling on malaria control in pregnancy and the importance of attending antenatal clinics and promoted these messages to pregnant women. In the intervention group community health workers also distributed SP to pregnant women.
In the control area, coverage of intermittent preventive treatment during pregnancy (>2 doses) was low before (44.1%) and during the intervention (46.1%). In the intervention area, coverage increased from 41.5% to 82.9% (P < 0.01). Antenatal clinic attendance (>2 visits) was maintained in control villages at above 90%, but fell in intervention villages from 87.3% to 51.5% (P < 0.01). Post-natal malaria parasitaemia prevalence fell in women from both study areas during the intervention phase (P < 0.05). Increasing the coverage of intermittent preventive treatment during pregnancy to >40% did not significantly improve maternal haemoglobin or reduce low birthweight prevalence.
Better coverage of community-based intermittent preventive treatment during pregnancy can lower attendance at antenatal clinics; thus its effect on pregnancy outcome and antenatal attendance need to be monitored.
评估一项为期两年的以社区为基础提供周效磺胺-乙胺嘧啶（SP）方案对孕期间歇性预防治疗覆盖率、产前检查就诊率及妊娠结局的影响。
在马拉维南部奇夸瓦和恩加布政府医院的集水区选取了14个干预村和12个对照村。对以村为基础的社区卫生工作者进行了关于孕期疟疾控制的信息、教育和咨询培训，以及产前检查的重要性培训，并向孕妇宣传这些信息。在干预组，社区卫生工作者还向孕妇分发了SP。
在对照地区，孕期间歇性预防治疗的覆盖率（>2剂）在干预前较低（44.1%），在干预期间为46.1%。在干预地区，覆盖率从41.5%增至82.9%（P<0.01）。对照村的产前检查就诊率（>2次就诊）维持在90%以上，但干预村的就诊率从87.3%降至51.5%（P<0.01）。在干预阶段，两个研究地区的妇女产后疟疾寄生虫血症患病率均有所下降（P<0.05）。将孕期间歇性预防治疗的覆盖率提高到>40%并未显著改善孕妇血红蛋白水平或降低低体重儿患病率。
提高孕期以社区为基础的间歇性预防治疗覆盖率可降低产前检查就诊率；因此，需要监测其对妊娠结局和产前检查就诊率的影响。
