利用广义有序部分比例优势模型预测孕妇磺胺多辛-乙胺嘧啶摄取对出生体重的影响。

Predicting the effect of sulfadoxine-pyrimethamine uptake by pregnant women on birth weight using a generalized ordered partial proportional odds model.

机构信息

Department of Biostatistics, School of Public Health, University of Ghana, Legon-Accra, Ghana.

出版信息

BMC Pregnancy Childbirth. 2022 Mar 19;22(1):223. doi: 10.1186/s12884-022-04565-7.

DOI:10.1186/s12884-022-04565-7

PMID:35305604

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8933913/

Abstract

BACKGROUND

Low birth weight is a public health problem in Africa with the cause attributable to malaria in pregnancy. World Health Organization recommends the use of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine to prevent malaria during pregnancy. The objective of this study was to evaluate the prevalence and trajectories of birth weight and the direct impact and relationship between sulfadoxine-pyrimethamine and birth weight in Ghana since 2003.

METHOD

This study used secondary data obtained from the Demographic and Health Survey conducted in Ghana since 2003. Low birth weight was defined as weight < 2500 g irrespective of the gestational age of the foetus, while normal birth weight was between 2500 g to < 4000 g and macrosomia was = > 4000 g. In all the analysis, we adjusted for clustering, stratification and weighting to reduce bias and improve precision of the estimates. Analysis was performed on each survey year as well as the pooled dataset. The generalized ordered partial proportional odds model was used due to violations of the parallel regression model assumptions. Efforts were made to identify all confounding variables and these were adjusted for. Predictive analysis was also executed.

RESULTS

The overall prevalence of low birth weight was 9% while that of macrosomia was 13%. The low birth weight for 2003 was 12% while in 2008 it was 21% and then 68% in 2014. The mean birth weight of the children in 2014 was 3.16 (3.14, 3.19), 2008 was 3.37 (3.28, 3.45) and 2003 was 3.59 (3.49, 3.69) while that of the pooled data was 3.28 (3.25, 3.30). The adjusted model (taking into consideration all confounding variables) showed that non-uptake of SP could result in 51% odds of giving birth to a low-birth-weight compared with normal birth weight child. An insignificant result was observed between macrosomia and low birth weight.

CONCLUSION

There is higher probability that low birth weight could increase over the next couple of years if measures are not taking to reverse the current trajectories. The uptake of sulfadoxine-pyrimethamine should continue to be encouraged and recommended because it has a direct beneficial effect on the weight of the child.

摘要

背景

低出生体重是非洲的一个公共卫生问题，其病因可归咎于孕期疟疾。世界卫生组织建议在孕期使用磺胺多辛-乙胺嘧啶（SP）进行间歇性预防治疗（IPTp），以预防孕期疟疾。本研究旨在评估 2003 年以来加纳出生体重的流行率和轨迹，以及磺胺多辛-乙胺嘧啶与出生体重的直接影响和关系。

方法

本研究使用了 2003 年以来在加纳进行的人口与健康调查的二手数据。低出生体重定义为体重<2500 克，无论胎儿的胎龄如何，而正常出生体重为 2500 克至<4000 克，巨大儿为>=4000 克。在所有分析中，我们调整了聚类、分层和加权，以减少偏倚并提高估计的精度。我们对每个调查年份以及汇总数据集进行了分析。由于违反平行回归模型假设，因此使用广义有序部分比例优势模型。我们努力识别所有混杂变量，并对其进行了调整。还进行了预测分析。

结果

低出生体重的总体流行率为 9%，而巨大儿的流行率为 13%。2003 年的低出生体重率为 12%，2008 年为 21%，2014 年为 68%。2014 年儿童的平均出生体重为 3.16（3.14，3.19），2008 年为 3.37（3.28，3.45），2003 年为 3.59（3.49，3.69），而汇总数据为 3.28（3.25，3.30）。调整模型（考虑到所有混杂变量）显示，与正常出生体重的儿童相比，不服用磺胺多辛-乙胺嘧啶可能导致出生低体重的几率增加 51%。巨大儿和低出生体重之间的结果没有显著性差异。