Corrêa Gustavo, Das Mrinalini, Kovelamudi Rama, Jaladi Nagendra, Pignon Charlotte, Vysyaraju Kalyan, Yedla Usha, Laxmi Vijya, Vemula Pavani, Gowthami Vijaya, Sharma Hemant, Remartinez Daniel, Kalon Stobdan, de Polnay Kirrily, De Smet Martin, Isaakidis Petros
Médecins sans Frontières, Bhadrachalam, Khammam District, Telangana, 507111 India.
Médecins Sans Frontières, Brussels, 46, Rue de l'Arbre Bénit, 1050 Brussels, Belgium.
Confl Health. 2017 Jun 20;11:10. doi: 10.1186/s13031-017-0113-1. eCollection 2017.
With more than 200 million cases a year, malaria is an important global health concern, especially among pregnant women. The forested tribal areas of Andhra Pradesh, Telangana and Chhattisgarh in India are affected by malaria and by an on-going chronic conflict which seriously limits access to health care. The burden of malaria and anemia among pregnant women in these areas is unknown; moreover there are no specific recommendations for pregnant women in the Indian national malaria policy. The aim of this study is to measure the burden of malaria and anemia among pregnant women presenting in mobile clinics for antenatal care in a conflict-affected corridor in India.
This is a descriptive study of routine programme data of women presenting at first visit for antenatal care in Médecins sans Frontières mobile clinics during 1 year (2015). Burden of malaria and anemia were estimated using rapid diagnostic tests (SD BIOLINE® and HemoCue® respectively).
Among 575 pregnant women (median age: 26 years, interquartile range: 25-30) 29% and 22% were in their first and second pregnancies respectively. Mid-Upper Arm Circumference (MUAC) was below 230 mm in 74% of them. The prevalence of anemia was 92.4% (95% Confidence Intervals (CI): 89.9-94.3), while severe anemia was identified in 6.9% of the patients. The prevalence of malaria was 29.3% (95%CI: 25.7-33.2) with 64% caused by isolated , 35% by either or mixed malaria and 1% by either , or or . Malaria test was positive in 20.8% of asymptomatic cases. Malaria was associated with severe anemia (prevalence ratio: 2.56, 95%CI: 1.40-4.66, < 0.01).
Systematic screening for malaria and anemia should be integrated into maternal and child health services for conflict affected populations in highly endemic tribal areas. Interventions should include the use of rapid diagnostic test for all pregnant women at every visit, regardless of symptoms. Further studies should evaluate the impact of this intervention alone or in combination with intermittent malaria preventive treatment.
疟疾每年发病超过2亿例，是一个重要的全球卫生问题，在孕妇中尤为如此。印度安得拉邦、特伦甘纳邦和恰蒂斯加尔邦的森林部落地区受到疟疾以及持续的长期冲突影响，这严重限制了医疗服务的可及性。这些地区孕妇的疟疾和贫血负担尚不清楚；此外，印度国家疟疾政策中也没有针对孕妇的具体建议。本研究的目的是测量在印度一个受冲突影响地带的流动诊所接受产前护理的孕妇中的疟疾和贫血负担。
这是一项对2015年期间在无国界医生组织流动诊所首次就诊接受产前护理的妇女的常规项目数据进行的描述性研究。分别使用快速诊断检测（SD BIOLINE®和HemoCue®）估计疟疾和贫血负担。
在575名孕妇（中位年龄：26岁，四分位间距：25 - 30岁）中，分别有29%和22%处于首次和第二次怀孕。74%的孕妇上臂中段周长（MUAC）低于230毫米。贫血患病率为92.4%（95%置信区间（CI）：89.9 - 94.3），而6.9%的患者被诊断为重度贫血。疟疾患病率为29.3%（95%CI：25.7 - 33.2），其中64%由间日疟原虫单独引起，35%由三日疟原虫或混合感染引起，1%由卵形疟原虫或恶性疟原虫引起。20.8%的无症状病例疟疾检测呈阳性。疟疾与重度贫血相关（患病率比：2.56，95%CI：1.40 - 4.66，P < 0.01）。
应将疟疾和贫血的系统筛查纳入高度流行部落地区受冲突影响人群的母婴健康服务中。干预措施应包括每次就诊时对所有孕妇使用快速诊断检测，无论其有无症状。进一步的研究应评估这一干预措施单独或与间歇性疟疾预防性治疗联合使用的效果。
