Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Malar J. 2011 Dec 29;10:385. doi: 10.1186/1475-2875-10-385.
Malaria in pregnant women has been shown to be associated with low birth weight, stillbirth and mortality in newborns. The WHO has adopted the use of sulphadoxine-pyrimethamine (SP) to control malaria, a disease which worsens the plight of pregnant women leading to low birth weight, stillbirths and increased neonatal mortality. The present study assessed the effectiveness of SP and perception of its use in pregnant women in Offinso district (Ashanti Region), Ghana.
Pregnant women, gestational age 32 weeks prior to term, were studied from November 2006 to October 2007. Their haemoglobin levels (Hb), parasitaemia and other quantitative determinants were assessed. In-depth interviews (IDIs) and focus group discussions (FGDs) were used to assess the perception of SP usage and its effectiveness.
Of the 306 study participants, 92 (30%) took one dose, 100 (33%) two doses and 114 (37%) three doses of SP, respectively. There was significant association between gravidity and SP dosage taken (Pearson χ2 = 18.9, p < 0.001). Although adverse effects were produced in 113 (i.e. 37%) of the pregnant women, no significant difference was observed with regard to the dosage of SP taken (Pearson's χ2 = 2.3, p ≥ 0.32). Peripheral parasitaemia was present in 47 (15%) of the subjects. There was a poor negative relationship of doses of SP with parasitaemia (r = -0.07, p ≥ 0.24). Mean Hb was 11.3 ± 1.6 g/dl, with 118 (39%) of the subjects anaemic (Hb < 11.0 g/dl), whilst 187 (61%) were normal (Hb ≥11.0 g/dl). Significant positive correlation of SP use with Hb level (r = 0.15, p < 0.008) was observed. SP use reduced malaria and anaemia prevalence, contributed to reduced maternal morbidity with mild side effects being reported.
This study points to the effectiveness of IPTp using SP as an evidence-based measure for control of malaria and malaria-related anaemia in pregnancy. Therefore, the Ghana Health Service should improve current programme strategies to increase the proportion of pregnant women who take three doses of SP, paying attention to improved face-to-face health education, focussed antenatal care and better social mobilization.
已有研究表明，孕妇疟疾与新生儿低体重、死产和死亡率有关。世界卫生组织（WHO）已采用磺胺多辛-乙胺嘧啶（SP）来控制疟疾，这种疾病使孕妇的困境恶化，导致低体重、死产和新生儿死亡率增加。本研究评估了在加纳阿散蒂地区奥芬索区（Offinso district），SP 控制疟疾的有效性及其在孕妇中的应用情况。
2006 年 11 月至 2007 年 10 月期间，研究了妊娠 32 周前的孕妇。评估了她们的血红蛋白水平（Hb）、寄生虫血症和其他定量指标。采用深入访谈（IDIs）和焦点小组讨论（FGDs）评估 SP 使用情况及其效果的认知。
在 306 名研究参与者中，92 名（30%）服用了一剂 SP，100 名（33%）服用了两剂 SP，114 名（37%）服用了三剂 SP。孕妇的孕次与服用的 SP 剂量之间存在显著关联（Pearson χ2=18.9，p<0.001）。尽管 113 名（即 37%）孕妇出现了不良反应，但服用的 SP 剂量没有观察到显著差异（Pearson's χ2=2.3，p≥0.32）。47 名（15%）受试者外周寄生虫血症阳性。SP 剂量与寄生虫血症呈不良负相关（r=-0.07，p≥0.24）。平均 Hb 为 11.3±1.6 g/dl，118 名（39%）受试者贫血（Hb<11.0 g/dl），187 名（61%）为正常（Hb≥11.0 g/dl）。观察到 SP 使用与 Hb 水平呈显著正相关（r=0.15，p<0.008）。SP 使用降低了疟疾和贫血的患病率，减少了产妇发病率，且报告了轻微的副作用。
本研究表明，IPTp 使用 SP 作为控制妊娠疟疾和疟疾相关贫血的循证措施是有效的。因此，加纳卫生服务部门应改进当前的方案策略，提高服用三剂 SP 的孕妇比例，注重改善面对面的健康教育、重点产前护理和更好的社会动员。
