Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop H24-3, Atlanta, GA, 30329, USA.
The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Malar J. 2020 Aug 5;19(1):282. doi: 10.1186/s12936-020-03356-9.
Malaria in pregnancy is responsible for 8-14% of low birth weight and 20% of stillbirths in sub-Saharan Africa. To prevent these adverse consequences, the World Health Organization recommends intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine be administered at each ANC visit starting as early as possible in the second trimester. Global IPTp coverage in targeted countries remains unacceptably low. Community delivery of IPTp was explored as a means to improve coverage.
A cluster randomized, controlled trial was conducted in 12 health facilities in a 1:1 ratio to either an intervention group (IPTp delivered by CHWs) or a control group (standard practice, with IPTp delivered at HFs) in three districts of Burkina Faso to assess the effect of IPTp administration by community health workers (CHWs) on the coverage of IPTp and antenatal care (ANC). The districts and facilities were purposively selected taking into account malaria epidemiology, IPTp coverage, and the presence of active CHWs. Pre- and post-intervention surveys were carried out in March 2017 and July-August 2018, respectively. A difference in differences (DiD) analysis was conducted to assess the change in coverage of IPTp and ANC over time, accounting for clustering at the health facility level.
Altogether 374 and 360 women were included in the baseline and endline surveys, respectively. At baseline, women received a median of 2.1 doses; by endline, women received a median of 1.8 doses in the control group and 2.8 doses in the intervention group (p-value < 0.0001). There was a non-statistically significant increase in the proportion of women attending four ANC visits in the intervention compared to control group (DiD = 12.6%, p-value = 0.16). By the endline, administration of IPTp was higher in the intervention than control, with a DiD of 17.6% for IPTp3 (95% confidence interval (CI) - 16.3, 51.5; p-value 0.31) and 20.0% for IPTp4 (95% CI - 7.2, 47.3; p-value = 0.15).
Community delivery of IPTp could potentially lead to a greater number of IPTp doses delivered, with no apparent decrease in ANC coverage.
在撒哈拉以南非洲地区，疟疾导致孕妇所生婴儿体重不足的比例为 8-14%，死产比例为 20%。为避免这些不良后果，世界卫生组织建议在每个产前检查时，对孕妇进行磺胺多辛-乙胺嘧啶间歇性预防治疗（IPTp），起始时间最早可在妊娠中期。目标国家的全球 IPTp 覆盖率仍然低得令人无法接受。社区提供 IPTp 作为提高覆盖率的一种手段进行了探讨。
在布基纳法索的三个区的 12 个卫生机构中，以 1:1 的比例进行了一项集群随机对照试验，一组为干预组（由社区卫生工作者提供 IPTp），一组为对照组（标准做法，在卫生机构提供 IPTp），以评估社区卫生工作者（CHWs）提供 IPTp 对 IPTp 和产前护理（ANC）覆盖率的影响。这些区和机构是根据疟疾流行病学、IPTp 覆盖率和活跃的 CHWs 情况有目的地选择的。分别于 2017 年 3 月和 2018 年 7 月至 8 月进行了干预前和干预后调查。采用差异分析（DiD）评估了随时间推移，IPTp 和 ANC 覆盖率的变化，同时考虑了卫生机构层面的聚类。
基线和终线调查分别纳入了 374 名和 360 名妇女。基线时，妇女接受了中位数为 2.1 剂；终线时，对照组妇女接受了中位数为 1.8 剂，干预组妇女接受了中位数为 2.8 剂（p 值<0.0001）。与对照组相比，干预组接受 4 次 ANC 就诊的妇女比例有所增加（差异为 12.6%，p 值=0.16），但差异无统计学意义。到终线时，干预组的 IPTp 给药率高于对照组，IPTp3 的差异为 17.6%（95%置信区间（CI）-16.3，51.5；p 值=0.31），IPTp4 的差异为 20.0%（95%CI-7.2，47.3；p 值=0.15）。
社区提供 IPTp 可能会导致更多的 IPTp 剂量给药，而 ANC 覆盖率没有明显下降。
