Clinic of Pediatric Hematology-Oncology, Department of Pediatrics, University of Padova, Padova, Italy.
BMC Infect Dis. 2011 Mar 2;11:57. doi: 10.1186/1471-2334-11-57.
Malaria and Tuberculosis (TB) are important causes of morbidity and mortality in Africa. Malaria prevention reduces mortality among HIV patients, pregnant women and children, but its role in TB patients is not clear. In the TB National Reference Center in Guinea-Bissau, admitted patients are in severe clinical conditions and mortality during the rainy season is high. We performed a three-step malaria prevention program to reduce mortality in TB patients during the rainy season.
Since 2005 Permethrin treated bed nets were given to every patient. Since 2006 environmental prevention with permethrin derivates was performed both indoor and outdoor during the rainy season. In 2007 cotrimoxazole prophylaxis was added during the rainy season. Care was without charge; health education on malaria prevention was performed weekly. Primary outcomes were death, discharge, drop-out.
427, 346, 549 patients were admitted in 2005, 2006, 2007, respectively. Mortality dropped from 26.46% in 2005 to 18.76% in 2007 (p-value 0.003), due to the significant reduction in rainy season mortality (death/discharge ratio: 0.79, 0.55 and 0.26 in 2005, 2006 and 2007 respectively; p-value 0.001) while dry season mortality remained constant (0.39, 0.37 and 0.32; p-value 0.647). Costs of malaria prevention were limited: 2€/person. No drop-outs were observed. Health education attendance was 96-99%.
Malaria prevention in African tertiary care hospitals seems feasible with limited costs. Vector control, personal protection and cotrimoxazole prophylaxis seem to reduce mortality in severely ill TB patients. Prospective randomized trials are needed to confirm our findings in similar settings.
疟疾和结核病（TB）是非洲发病率和死亡率的重要原因。疟疾预防可降低艾滋病毒感染者、孕妇和儿童的死亡率，但在结核病患者中的作用尚不清楚。在几内亚比绍的国家结核病参考中心，入院患者病情严重，雨季死亡率较高。我们实施了一个三步疟疾预防计划，以降低雨季结核病患者的死亡率。
自 2005 年以来，为每位患者提供了经驱虫处理的蚊帐。自 2006 年以来，在雨季期间，室内外均使用了含拟除虫菊酯的环境预防措施。2007 年，雨季期间增加了复方磺胺甲噁唑预防。护理是免费的；每周进行疟疾预防健康教育。主要结局是死亡、出院、脱落。
2005 年、2006 年和 2007 年分别有 427、346 和 549 名患者入院。死亡率从 2005 年的 26.46%降至 2007 年的 18.76%（p 值<0.003），这是由于雨季死亡率显著下降（死亡/出院比：2005 年、2006 年和 2007 年分别为 0.79、0.55 和 0.26；p 值<0.001），而旱季死亡率保持不变（0.39、0.37 和 0.32；p 值=0.647）。疟疾预防费用有限：每人 2 欧元。未观察到脱落。健康教育出勤率为 96-99%。
在非洲三级保健医院进行疟疾预防似乎是可行的，费用有限。病媒控制、个人防护和复方磺胺甲噁唑预防似乎可以降低重症结核病患者的死亡率。需要进行前瞻性随机试验来证实我们在类似环境中的发现。
