Rulisa Stephen, Mens Pètra F, Karema Corine, Schallig Henk D F H, Kaligirwa Nadine, Vyankandondera Joseph, de Vries Peter J
National University of Rwanda, Kigali University Teaching Hospital, BP 655, Kigali, Rwanda.
Malar J. 2009 Aug 10;8:194. doi: 10.1186/1475-2875-8-194.
Malaria has a negative effect on pregnancy outcome, causing low birth weight, premature birth and stillbirths, particularly in areas with high malaria transmission. In Rwanda, malaria transmission intensity ranges from high to nil, probably associated with variable altitudes. Overall, the incidence decreased over the last six years (2002-2007). Therefore, the impact of malaria on birth outcomes is also expected to vary over time and space.
Obstetric indicators (birth weight and pregnancy outcome) and malaria incidence were compared and analyzed to their association over time (2002-2007) and space. Birth data from 12,526 deliveries were collected from maternity registers of 11 different primary health centers located in different malaria endemic areas. Malaria data for the same communities were collected from the National Malaria Control Programme. Associations were sought with mixed effects models and logistic regression.
In all health centres, a significant increase of birth weight over the years was observed (p < 0.001) with a significant seasonal fluctuation. Malaria incidence had no significant effect on birth weight. There was a slight but significant decreasing effect of malaria incidence on the occurrence of premature delivery (p-value 0.045) and still birth (p-value 0.009). Altitude showed a slight but significant negative correlation with birth weight. Overall, a decrease over the years of premature delivery (p = 0.010) and still birth (p = 0.036) was observed.
In Rwanda, birth weight and pregnancy outcome are not directly influenced by malaria, which is in contrast to many other studied areas. Although malaria incidence overall has declined and mean birth weight increased over the studied period, no direct association was found between the two. Socio-economic factors and improved nutrition could be responsible for birth weight changes in recent years.
疟疾对妊娠结局有负面影响，可导致低出生体重、早产和死产，尤其是在疟疾传播率高的地区。在卢旺达，疟疾传播强度从高到无，这可能与不同的海拔高度有关。总体而言，发病率在过去六年（2002 - 2007年）有所下降。因此，预计疟疾对出生结局的影响也会随时间和空间而变化。
比较并分析产科指标（出生体重和妊娠结局）与疟疾发病率在时间（2002 - 2007年）和空间上的关联。从位于不同疟疾流行地区的11个不同初级卫生中心的产妇登记册中收集了12526例分娩的出生数据。同一社区的疟疾数据从国家疟疾控制计划中收集。采用混合效应模型和逻辑回归寻求关联。
在所有卫生中心，观察到多年来出生体重显著增加（p < 0.001），且有显著的季节性波动。疟疾发病率对出生体重没有显著影响。疟疾发病率对早产（p值0.045）和死产（p值0.009）的发生有轻微但显著的降低作用。海拔高度与出生体重呈轻微但显著的负相关。总体而言，观察到多年来早产（p = 0.010）和死产（p = 0.036）有所下降。
在卢旺达，出生体重和妊娠结局不受疟疾直接影响，这与许多其他研究地区不同。尽管在研究期间疟疾发病率总体下降且平均出生体重增加，但两者之间未发现直接关联。社会经济因素和营养改善可能是近年来出生体重变化的原因。
