Heymann D L, Steketee R W, Wirima J J, McFarland D A, Khoromana C O, Campbell C C
Combatting Childhood Communicable Diseases Program, Ministry of Health, Malawi.
Trans R Soc Trop Med Hyg. 1990 Jul-Aug;84(4):496-8. doi: 10.1016/0035-9203(90)90011-3.
The roles of Plasmodium falciparum resistance to chloroquine and compliance in the protective efficacy of the antenatal chloroquine prophylaxis programme in Malawi were evaluated by interviewing pregnant women attending antenatal clinics and examining them for P. falciparum parasites in thick smears and chloroquine metabolites in urine. 36% of 642 women had urine chloroquine metabolite levels compatible with regular compliance to the weekly chloroquine dosage schedule. Among a subgroup of 288 pregnant women who were provided weekly prophylaxis under supervision for 4 consecutive weeks, P. falciparum infection rates were 37%, representing the failure of chloroquine to eliminate P. falciparum in Malawi. Among pregnant women not taking prophylaxis, the P. falciparum infection rate was 48%. Based on the P. falciparum infection rates among these 2 groups of women, the protective efficacy of CQ chloroquine was estimated as 23%. If the 36% of pregnant women who had chloroquine in their urines accurately estimates the proportion of women who comply with the prophylaxis programme in Malawi, the actual protective efficacy of the programme would be 8%. The cost of preventing one P. falciparum infection among pregnant women in the Malawi programme is estimated at US$ 10.87. This is an unacceptably high cost in much of Africa, and research is required to define more cost-effective interventions, including more effective drugs, and health education programmes to improve compliance among pregnant women.
通过对到产前诊所就诊的孕妇进行访谈，并检查她们厚血涂片上的恶性疟原虫寄生虫以及尿液中的氯喹代谢物，评估了马拉维产前氯喹预防方案中恶性疟原虫对氯喹的耐药性和依从性在其预防效果中的作用。642名妇女中有36%的尿液氯喹代谢物水平与每周氯喹剂量方案的常规依从性相符。在连续4周接受每周一次监督预防的288名孕妇亚组中，恶性疟原虫感染率为37%，这表明氯喹在马拉维未能消除恶性疟原虫。在未进行预防的孕妇中，恶性疟原虫感染率为48%。根据这两组妇女中的恶性疟原虫感染率，估计氯喹的预防效果为23%。如果尿液中含有氯喹的36%孕妇准确估计了马拉维遵守预防方案的妇女比例，那么该方案的实际预防效果将为8%。在马拉维方案中，预防一名孕妇感染恶性疟原虫的成本估计为10.87美元。在非洲大部分地区，这一成本高得令人无法接受，因此需要开展研究来确定更具成本效益的干预措施，包括更有效的药物以及提高孕妇依从性的健康教育方案。
