Howard Natasha, Enayatullah Sayed, Mohammad Nader, Mayan Ismail, Shamszai Zohra, Rowland Mark, Leslie Toby
London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
HealthNet-TPO (HNTPO), Kabul, Afghanistan.
Malar J. 2015 Nov 4;14:431. doi: 10.1186/s12936-015-0964-0.
Afghanistan has some of the worst maternal and infant mortality indicators in the world and malaria is a significant public health concern. Study objectives were to assess prevalence of malaria and anaemia, related knowledge and practices, and malaria prevention barriers among pregnant women in eastern Afghanistan.
Three studies were conducted: (1) a clinical survey of maternal malaria, maternal anaemia, and neonatal birthweight in a rural district hospital delivery-ward; (2) a case-control study of malaria risk among reproductive-age women attending primary-level clinics; and (3) community surveys of malaria and anaemia prevalence, socioeconomic status, malaria knowledge and reported behaviour among pregnant women.
Among 517 delivery-ward participants (1), one malaria case (prevalence 1.9/1000), 179 anaemia cases (prevalence 346/1000), and 59 low-birthweight deliveries (prevalence 107/1000) were detected. Anaemia was not associated with age, gravidity, intestinal parasite prevalence, or low-birthweight at delivery. Among 141 malaria cases and 1010 controls (2), no association was found between malaria infection and pregnancy (AOR 0.89; 95 % CI 0.57-1.39), parity (AOR 0.95; 95 % CI 0.85-1.05), age (AOR 1.02; 95 % CI 1.00-1.04), or anaemia (AOR 1.00; 95 % CI 0.65-1.54). Those reporting insecticide-treated net usage had 40 % reduced odds of malaria infection (AOR 0.60; 95 % CI 0.40-0.91). Among 530 community survey participants (3), malaria and anaemia prevalence were 3.9/1000 and 277/1000 respectively, with 34/1000 experiencing severe anaemia. Despite most women having no formal education, malaria knowledge was high. Most expressed reluctance to take malaria preventive medication during pregnancy, deeming it potentially unsafe.
Given the low malaria risk and reported avoidance of medication during pregnancy, intermittent preventive treatment is hard to justify or implement. Preventive strategy should instead focus on long-lasting insecticidal nets for all pregnant women.
阿富汗是世界上孕产妇和婴儿死亡率最高的国家之一，疟疾是一个重大的公共卫生问题。研究目的是评估阿富汗东部孕妇的疟疾和贫血患病率、相关知识与实践，以及疟疾预防障碍。
开展了三项研究：（1）在一家农村地区医院产房对孕产妇疟疾、孕产妇贫血和新生儿出生体重进行临床调查；（2）对在基层诊所就诊的育龄妇女进行疟疾风险病例对照研究；（3）对孕妇的疟疾和贫血患病率、社会经济状况、疟疾知识及报告行为进行社区调查。
在517名产房参与者中（1），检测到1例疟疾病例（患病率1.9/1000）、179例贫血病例（患病率346/1000）和59例低体重儿分娩（患病率107/1000）。贫血与年龄、妊娠次数、肠道寄生虫患病率或分娩时低体重无关。在141例疟疾病例和1010名对照者中（2），未发现疟疾感染与妊娠（比值比0.89；95%置信区间0.57 - 1.39）、产次（比值比0.95；95%置信区间0.85 - 1.05）、年龄（比值比1.02；95%置信区间1.00 - 1.04）或贫血（比值比1.00；95%置信区间0.65 - 1.54）之间存在关联。报告使用经杀虫剂处理蚊帐的人感染疟疾的几率降低了40%（比值比0.60；95%置信区间0.40 - 0.91）。在530名社区调查参与者中（3），疟疾和贫血患病率分别为3.9/1000和277/1000，其中34/1000患有严重贫血。尽管大多数妇女未接受过正规教育，但疟疾知识知晓率较高。大多数人表示在孕期不愿服用疟疾预防药物，认为其可能不安全。
鉴于疟疾风险较低且报告显示孕期避免用药，间歇性预防治疗难以证明其合理性或实施。预防策略应转而侧重于为所有孕妇提供长效驱虫蚊帐。
