Department of Medicine (RMH/WH), Centre for Molecular, Environmental, Genetic & Analytic Epidemiology, School of Population Health, University of Melbourne, Melbourne, Australia.
PLoS One. 2010 Aug 6;5(8):e12012. doi: 10.1371/journal.pone.0012012.
BACKGROUND: The World Health Organization recommends insecticidal bednets and intermittent preventive treatment to reduce malaria in pregnancy. Longitudinal data of malaria prevalence and pregnancy outcomes are valuable in gauging the impact of these antimalarial interventions. METHODOLOGY/PRINCIPAL FINDINGS: We recruited 8,131 women delivering in a single Malawian hospital over 9 years. We recorded demographic data, antenatal prescription of intermittent preventive therapy during pregnancy with sulfadoxine-pyrimethamine and bed net use, and examined finger-prick blood for malaria parasites and hemoglobin concentration. In 4,712 women, we examined placental blood for malaria parasites and recorded the infant's birth weight. Peripheral and placental parasitemia prevalence declined from 23.5% to 5.0% and from 25.2% to 6.8% respectively. Smaller declines in prevalence of low birth weight and anemia were observed. Coverage of intermittent preventive treatment and bednets increased. Number of sulfadoxine-pyrimethamine doses received correlated inversely with placental parasitemia (Odds Ratio (95% CI): 0.79 (0.68, 0.91)), maternal anemia (0.81, (0.73, 0.90)) and low birth weight from 1997-2001 (0.63 (0.53, 0.75)), but not from 2002-2006. Bednet use protected from peripheral parasitemia (0.47, (0.37, 0.60)) and placental parasitemia (0.41, (0.31, 0.54)) and low birth weight (0.75 (0.59, 0.95)) but not anemia throughout the study. Compared to women without nets who did not receive 2-dose sulfadoxine-pyrimethamine, women using nets and receiving 2-dose sulfadoxine-pyrimethamine were less likely to have parasitemia or low birth weight babies. Women receiving 2-dose sulfadoxine-pyrimethamine alone had little evidence of protection whereas bednets alone gave intermediate protection. CONCLUSIONS/SIGNIFICANCE: Increased bednet coverage explains changes in parasitemia and birth weight among pregnant women better than sulfadoxine-pyrimethamine use. High bed net coverage, and sulfadoxine-pyrimethamine resistance, may be contributing to its apparent loss of effectiveness.
背景：世界卫生组织建议使用杀虫蚊帐和间歇性预防治疗来减少妊娠期间的疟疾。疟疾流行率和妊娠结局的纵向数据对于评估这些抗疟干预措施的影响非常有价值。
方法/主要发现：我们招募了 9 年来在马拉维一家医院分娩的 8131 名妇女。我们记录了人口统计学数据、妊娠期间使用磺胺多辛-乙胺嘧啶的间歇性预防治疗处方和蚊帐使用情况，并检查了手指刺破的血液中的疟原虫和血红蛋白浓度。在 4712 名妇女中，我们检查了胎盘血液中的疟原虫，并记录了婴儿的出生体重。外周和胎盘寄生虫血症的患病率分别从 23.5%降至 5.0%和从 25.2%降至 6.8%。观察到低出生体重和贫血的患病率下降较小。间歇性预防治疗和蚊帐的覆盖率增加。接受的磺胺多辛-乙胺嘧啶剂量与胎盘寄生虫血症（优势比（95%置信区间）：0.79（0.68，0.91））、母亲贫血症（0.81（0.73，0.90））和低出生体重（1997-2001 年）呈负相关（0.63（0.53，0.75）），但与 2002-2006 年无关。使用蚊帐可预防外周寄生虫血症（0.47（0.37，0.60））和胎盘寄生虫血症（0.41（0.31，0.54））以及低出生体重（0.75（0.59，0.95）），但在整个研究过程中都不会贫血。与未使用蚊帐且未接受 2 剂磺胺多辛-乙胺嘧啶的妇女相比，使用蚊帐并接受 2 剂磺胺多辛-乙胺嘧啶的妇女发生寄生虫血症或低体重婴儿的可能性较小。单独接受 2 剂磺胺多辛-乙胺嘧啶治疗的妇女几乎没有保护作用，而单独使用蚊帐则具有中等保护作用。
结论/意义：蚊帐覆盖率的增加比磺胺多辛-乙胺嘧啶的使用更好地解释了孕妇寄生虫血症和出生体重的变化。高蚊帐覆盖率和磺胺多辛-乙胺嘧啶耐药性可能是其有效性明显丧失的原因。
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