Department of Global Health, University of Washington, Seattle, WA, USA.
Malar J. 2011 Jun 6;10:152. doi: 10.1186/1475-2875-10-152.
Prompt use of an effective anti-malarial drug is essential for controlling malaria and its adverse effects in pregnancy. The World Health Organization recommends an artemisinin-based combination therapy as the first-line treatment of uncomplicated malaria in the second and third trimesters of pregnancy. The study objective was to determine the degree to which presumed episodes of uncomplicated symptomatic malaria in pregnancy were treated with a recommended anti-malarial regimen in a region of Uganda.
Utilizing a population-based random sample, we interviewed women living in Jinja, Uganda who had been pregnant in the past year.
Self-reported malaria during the index pregnancy was reported among 67% (n = 334) of the 500 participants. Among the 637 self-reported episodes of malaria, an anti-malarial drug was used for treatment in 85% of the episodes. Use of a currently recommended treatment in the first trimester was uncommon (5.6%). A contraindicated anti-malarial drug (sulphadoxine-pyrimethamine and/or artemether-lumefantrine) was involved in 70% of first trimester episodes. Recommended anti-malarials were used according to the guidelines in only 30.1% of all second and third trimester episodes.
Self-reported malaria was extremely common in this population and adherence to treatment guidelines for the management of malaria in pregnancy was poor. Use of artemether-lumefantrine combined with non-recommended anti-malarials was common practice. Overuse of anti-malarial drugs, especially ones that are no longer recommended, undermines malaria control efforts by fueling the spread of drug resistance and delaying appropriate treatment of non-malarial febrile illnesses. Improved diagnostic capacity is essential to ultimately improving the management of malaria-like symptoms during pregnancy and appropriate use of currently available anti-malarials.
及时使用有效的抗疟药物对于控制疟疾及其在妊娠中的不良影响至关重要。世界卫生组织建议，在妊娠第二和第三孕期，青蒿素为基础的联合疗法是治疗无并发症疟疾的一线药物。本研究的目的是确定在乌干达的一个地区，有多少被认为是无并发症有症状疟疾的妊娠病例，是按照推荐的抗疟方案进行治疗的。
我们利用基于人群的随机抽样方法，对过去一年在乌干达 Jinja 地区怀孕的妇女进行了访谈。
500 名参与者中，有 67%（n=334）报告了在指数妊娠期间曾患有疟疾。在 637 例自我报告的疟疾病例中，有 85%的病例使用了抗疟药物进行治疗。在第一孕期使用目前推荐的治疗方法并不常见（5.6%）。有 70%的第一孕期病例使用了禁忌抗疟药物（磺胺多辛-乙胺嘧啶和/或青蒿琥酯-甲氟喹）。只有 30.1%的所有第二和第三孕期病例按照指南使用了推荐的抗疟药物。
在该人群中，自我报告的疟疾非常常见，而且妊娠期间管理疟疾的治疗指南的遵循情况很差。青蒿琥酯-甲氟喹联合使用不推荐的抗疟药物是常见的做法。过度使用抗疟药物，特别是不再推荐使用的药物，会助长耐药性的传播，并延迟对非疟疾性发热疾病的适当治疗，从而破坏疟疾控制工作。提高诊断能力对于最终改善妊娠期间类似疟疾症状的管理和适当使用现有的抗疟药物至关重要。
