肯尼亚产前诊所提供间歇性预防治疗和经杀虫剂处理的蚊帐以控制妊娠疟疾的效果。

Effectiveness of antenatal clinics to deliver intermittent preventive treatment and insecticide treated nets for the control of malaria in pregnancy in Kenya.

机构信息

Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.

出版信息

PLoS One. 2013 Jun 14;8(6):e64913. doi: 10.1371/journal.pone.0064913. Print 2013.

BACKGROUND

Malaria in pregnancy can have devastating consequences for mother and baby. Coverage with the WHO prevention strategy for sub-Saharan Africa of intermittent-preventive-treatment (IPTp) with two doses of sulphadoxine-pyrimethamine (SP) and insecticide-treated-nets (ITNs) in pregnancy is low. We analysed household survey data to evaluate the effectiveness of antenatal clinics (ANC) to deliver IPTp and ITNs to pregnant women in Nyando district, Kenya.

METHODS

We assessed the systems effectiveness of ANC to deliver IPTp and ITNs to pregnant women and the impact on low birthweight (LBW). Logistic regression was used to identify predictors of receipt of IPTp and ITN use during pregnancy.

RESULTS

Among 89% of recently pregnant women who attended ANC at least once between 4-9 months gestation, 59% reported receiving one dose of SP and 90% attended ANC again, of whom 57% received a second dose, resulting in a cumulative effectiveness for IPTp of 27%, most of whom used an ITN (96%). Overall ITN use was 89%, and ANC the main source (76%). Women were less likely to receive IPTp if they had low malaria knowledge (0.26, 95% CI 0.08-0.83), had a child who had died (OR 0.36, 95% CI 0.14-0.95), or if they first attended ANC late (OR 0.20, 95% CI 0.06-0.67). Women who experienced side effects to SP (OR 0.18, CI 0.03-0.90) or had low malaria knowledge (OR 0.78, 95% CI 0.11-5.43) were less likely to receive IPTp by directly observed therapy. Ineffective delivery of IPTp reduced its potential impact by 231 LBW cases averted (95% CI 64-359) per 10,000 pregnant women.

CONCLUSION

IPTp presents greater challenges to deliver through ANC than ITNs in this setting. The reduction in public health impact on LBW resulting from ineffective delivery of IPTp is estimated to be substantial. Urgent efforts are required to improve service delivery of this important intervention.

背景

妊娠疟疾对母婴都有毁灭性的影响。在撒哈拉以南非洲，世卫组织预防策略建议孕妇接受两次磺胺多辛-乙胺嘧啶（SP）间歇性预防治疗（IPT）和驱虫蚊帐（ITN），但覆盖率很低。我们分析了家庭调查数据，以评估肯尼亚尼亚安多地区的产前诊所（ANC）为孕妇提供 IPT 和 ITN 的效果。

方法

我们评估了 ANC 为孕妇提供 IPT 和 ITN 的系统效果及其对低出生体重（LBW）的影响。Logistic 回归用于确定接受 IPT 和 ITN 妊娠期间使用的预测因素。

结果

在 89%的最近怀孕且在 4-9 个月孕期至少接受过一次 ANC 的孕妇中，59%报告接受了一次 SP 剂量，90%再次接受 ANC，其中 57%接受了第二次剂量，导致 IPTp 的累积有效性为 27%，其中大多数人使用了 ITN（96%）。整体 ITN 使用率为 89%，ANC 是主要来源（76%）。如果孕妇疟疾知识水平较低（0.26，95%CI 0.08-0.83）、有儿童死亡（OR 0.36，95%CI 0.14-0.95）或首次 ANC 较晚（OR 0.20，95%CI 0.06-0.67），则不太可能接受 IPTp。对 SP 有副作用的妇女（OR 0.18，CI 0.03-0.90）或疟疾知识水平较低（OR 0.78，95%CI 0.11-5.43）不太可能通过直接观察疗法接受 IPTp。IPT 无效的实施减少了 231 例 LBW 病例的潜在影响（95%CI 64-359）/每 10000 名孕妇。