撒哈拉以南非洲地区妊娠期间疟疾和性传播及生殖器官感染的流行情况：系统评价。

Prevalence of malaria and sexually transmitted and reproductive tract infections in pregnancy in sub-Saharan Africa: a systematic review.

机构信息

Department of Disease Control, Malaria Centre, London School of Hygiene and Tropical Medicine, London, England.

出版信息

JAMA. 2012 May 16;307(19):2079-86. doi: 10.1001/jama.2012.3428.

DOI:10.1001/jama.2012.3428

PMID:22665107

Abstract

CONTEXT

Malaria and sexually transmitted infections/reproductive tract infections (STIs/RTIs) in pregnancy are direct and indirect causes of stillbirth, prematurity, low birth weight, and maternal and neonatal morbidity and mortality.

OBJECTIVE

To conduct a systematic review and meta-analysis of malaria and STI/RTI prevalence estimates among pregnant women attending antenatal care facilities in sub-Saharan Africa.

DATA SOURCES

PubMed, MEDLINE, EMBASE, the World Health Organization International Clinical Trials Registry, and reference lists were searched for studies reporting malaria, syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, or bacterial vaginosis among pregnant women attending antenatal care facilities in sub-Saharan Africa.

STUDY SELECTION

Included studies were conducted in 1990-2011 with open enrollment. Studies from South Africa, where malaria is no longer endemic, were excluded.

DATA EXTRACTION

Point prevalence estimates were corrected for diagnostic precision. A random-effects model meta-analysis was applied to produce pooled prevalence estimates.

RESULTS

A total of 171 studies met inclusion criteria, providing 307 point prevalence estimates for malaria or STIs/RTIs and including a total of 340 904 women. The pooled prevalence estimates (with 95% CIs and number of women with positive diagnosis) among studies in 1990-2011 in East and Southern Africa were as follows: syphilis, 4.5% (3.9%-5.1%; n = 8346 positive diagnoses), N gonorrhoeae, 3.7% (2.8%-4.6%; n = 626), C trachomatis, 6.9% (5.1%-8.6%; n = 350), T vaginalis, 29.1% (20.9%-37.2%; n = 5502), bacterial vaginosis, 50.8% (43.3%-58.4%; n = 4280), peripheral malaria, 32.0% (25.9%-38.0%; n = 11 688), and placental malaria, 25.8% (19.7%-31.9%; n = 1388). West and Central Africa prevalence estimates were as follows: syphilis, 3.5% (1.8%-5.2%; n = 851), N gonorrhoeae, 2.7% (1.7%-3.7%; n = 73), C trachomatis, 6.1% (4.0%-8.3%; n = 357), T vaginalis, 17.8% (12.4%-23.1%; n = 822), bacterial vaginosis, 37.6% (18.0%-57.2%; n = 1208), peripheral malaria, 38.2% (32.3%-44.1%; n = 12 242), and placental malaria, 39.9% (34.2%-45.7%; n = 4658).

CONCLUSION

The dual prevalence of malaria and STIs/RTIs in pregnancy among women who attend antenatal care facilities in sub-Saharan Africa is considerable, with the combined prevalence of curable STIs/RTIs being equal to, if not greater than, malaria.

摘要

背景

疟疾和性传播感染/生殖系统感染（STIs/RTIs）是导致死产、早产、低出生体重以及孕产妇和新生儿发病率和死亡率的直接和间接原因。

目的

对撒哈拉以南非洲地区产前保健机构就诊孕妇的疟疾和性传播感染/生殖系统感染（STIs/RTIs）患病率进行系统评价和荟萃分析。

数据来源

在 PubMed、MEDLINE、EMBASE、世界卫生组织国际临床试验注册平台和参考文献列表中检索了报道撒哈拉以南非洲地区产前保健机构就诊孕妇疟疾、梅毒、淋病奈瑟菌、沙眼衣原体、阴道毛滴虫或细菌性阴道病的研究。

研究选择

纳入的研究是在 1990-2011 年进行的，且开放登记。南非的研究被排除在外，因为那里已经不再流行疟疾。

数据提取

对诊断精度进行校正，以获得点患病率估计值。应用随机效应模型荟萃分析得出汇总患病率估计值。

结果

共有 171 项研究符合纳入标准，提供了 307 项疟疾或性传播感染/生殖系统感染的点患病率估计值，共纳入 340904 名女性。1990-2011 年东非和南非的研究中汇总患病率估计值（95%置信区间和阳性诊断的女性数量）如下：梅毒 4.5%（3.9%-5.1%；8346 例阳性诊断），淋病奈瑟菌 3.7%（2.8%-4.6%；626 例），沙眼衣原体 6.9%（5.1%-8.6%；350 例），阴道毛滴虫 29.1%（20.9%-37.2%；5502 例），细菌性阴道病 50.8%（43.3%-58.4%；4280 例），外周性疟疾 32.0%（25.9%-38.0%；11688 例），胎盘性疟疾 25.8%（19.7%-31.9%；1388 例）。西非和中非的患病率估计值如下：梅毒 3.5%（1.8%-5.2%；851 例），淋病奈瑟菌 2.7%（1.7%-3.7%；73 例），沙眼衣原体 6.1%（4.0%-8.3%；357 例），阴道毛滴虫 17.8%（12.4%-23.1%；822 例），细菌性阴道病 37.6%（18.0%-57.2%；1208 例），外周性疟疾 38.2%（32.3%-44.1%；12242 例），胎盘性疟疾 39.9%（34.2%-45.7%；4658 例）。