Jordan E. Cates, Daniel Westreich, Stephen R. Cole, and Steven Meshnick are with the Department of Epidemiology, University of North Carolina-Chapel Hill (UNC). Holger W. Unger is with the Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia. Melissa Bauserman is with the Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC. Linda Adair is with the Department of Nutrition, UNC. Stephen J. Rogerson is with the Department of Medicine at the Doherty Institute, The University of Melbourne.
Am J Public Health. 2018 Mar;108(3):399-406. doi: 10.2105/AJPH.2017.304251. Epub 2018 Jan 18.
To estimate the impact of hypothetical antimalarial and nutritional interventions (which reduce the prevalence of low midupper arm circumference [MUAC]) on the incidence of low birth weight (LBW).
We analyzed data from 14 633 pregnancies from 13 studies conducted across Africa and the Western Pacific from 1996 to 2015. We calculated population intervention effects for increasing intermittent preventive therapy in pregnancy (IPTp), full coverage with bed nets, reduction in malaria infection at delivery, and reductions in the prevalence of low MUAC.
We estimated that, compared with observed IPTp use, administering 3 or more doses of IPTp to all women would decrease the incidence of LBW from 9.9% to 6.9% (risk difference = 3.0%; 95% confidence interval = 1.7%, 4.0%). The intervention effects for eliminating malaria at delivery, increasing bed net ownership, and decreasing low MUAC prevalence were all modest.
Increasing IPTp uptake to at least 3 doses could decrease the incidence of LBW in malaria-endemic countries. The impact of IPTp on LBW was greater than the effect of prevention of malaria, consistent with a nonmalarial effect of IPTp, measurement error, or selection bias.
估计假设的抗疟和营养干预措施（降低低上臂中部周长[MUAC]的患病率）对低出生体重（LBW）发生率的影响。
我们分析了 1996 年至 2015 年间在非洲和西太平洋地区进行的 13 项研究中 14633 例妊娠的数据。我们计算了增加妊娠间歇性预防治疗（IPTp）、全覆盖蚊帐、降低分娩时疟疾感染和降低低 MUAC 患病率的人群干预效果。
与观察到的 IPTp 使用相比，我们估计为所有妇女提供 3 剂或更多剂 IPTp 将使 LBW 的发生率从 9.9%降至 6.9%（风险差异=3.0%；95%置信区间=1.7%，4.0%）。消除分娩时疟疾、增加蚊帐拥有率和降低低 MUAC 患病率的干预效果都不大。
将 IPTp 的使用率提高到至少 3 剂可能会降低疟疾流行国家的 LBW 发生率。IPTp 对 LBW 的影响大于预防疟疾的影响，这与 IPTp 的非疟疾效应、测量误差或选择偏差一致。
