室内残留喷洒与妊娠结局的关联：来自乌干达的一项准实验研究。

Association between indoor residual spraying and pregnancy outcomes: a quasi-experimental study from Uganda.

机构信息

Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.

Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, CA, USA.

出版信息

Int J Epidemiol. 2022 Oct 13;51(5):1489-1501. doi: 10.1093/ije/dyac043.

DOI:10.1093/ije/dyac043

PMID:35301532

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9557839/

Abstract

BACKGROUND

Malaria is a risk factor for adverse pregnancy outcomes. Indoor residual spraying with insecticide (IRS) reduces malaria infections, yet the effects of IRS on pregnancy outcomes are not well established. We evaluated the impact of a large-scale IRS campaign on pregnancy outcomes in Eastern Uganda.

METHODS

Birth records (n = 59 992) were obtained from routine surveillance data at 25 health facilities from five districts that were part of the IRS campaign and six neighbouring control districts ∼27 months before and ∼24 months after the start of the campaign (January 2013-May 2017). Campaign effects on low birthweight (LBW) and stillbirth incidence were estimated using the matrix completion method (MC-NNM), a machine-learning approach to estimating potential outcomes, and compared with the difference-in-differences (DiD) estimator. Subgroup analyses were conducted by HIV and gravidity.

RESULTS

MC-NNM estimates indicated that the campaign was associated with a 33% reduction in LBW incidence: incidence rate ratio (IRR) = 0.67 [95% confidence interval (CI): 0.49-0.93)]. DiD estimates were similar to MC-NNM [IRR = 0.69 (0.47-1.01)], despite a parallel trends violation during the pre-IRS period. The campaign was not associated with substantial reductions in stillbirth incidence [IRRMC-NNM = 0.94 (0.50-1.77)]. HIV status modified the effects of the IRS campaign on LBW [βIRSxHIV = 0.42 (0.05-0.78)], whereby HIV-negative women appeared to benefit from the campaign [IRR = 0.70 (0.61-0.81)], but not HIV-positive women [IRR = 1.12 (0.59-2.12)].

CONCLUSIONS

Our results support the effectiveness of the campaign in Eastern Uganda based on its benefit to LBW prevention, though HIV-positive women may require additional interventions. The IRS campaign was not associated with a substantively lower stillbirth incidence, warranting further research.

摘要

背景

疟疾是不良妊娠结局的一个风险因素。室内残留喷洒杀虫剂（IRS）可减少疟疾感染，但 IRS 对妊娠结局的影响尚不清楚。我们评估了在乌干达东部进行的一次大规模 IRS 运动对妊娠结局的影响。

方法

从五个参与 IRS 运动的地区和六个邻近对照地区的 25 个卫生设施的常规监测数据中获得了 59992 份出生记录（n），这些记录是在 IRS 运动开始前约 27 个月和开始后约 24 个月（2013 年 1 月至 2017 年 5 月）获得的。使用矩阵完成法（MC-NNM），一种估计潜在结果的机器学习方法，估计了低出生体重（LBW）和死产发生率的运动效应，并将其与差分差异（DiD）估计值进行了比较。根据 HIV 和孕次进行了亚组分析。

结果

MC-NNM 估计表明，该运动与 LBW 发生率降低 33%相关：发病率比（IRR）= 0.67 [95%置信区间（CI）：0.49-0.93)]。尽管在 IRS 前期间存在平行趋势违反，但 DiD 估计与 MC-NNM 相似[IRR=0.69（0.47-1.01）]。该运动与死产发生率的显著降低无关[IRRMC-NNM=0.94（0.50-1.77）]。HIV 状态改变了 IRS 运动对 LBW 的影响[βIRSxHIV=0.42（0.05-0.78）]，其中 HIV 阴性女性似乎受益于该运动[IRR=0.70（0.61-0.81）]，而 HIV 阳性女性则不然[IRR=1.12（0.59-2.12）]。