Centre Suisse de Recherches Scientifiques en Côte d'Ivoires, Abidjan, Côte d'Ivoire
Swiss Tropical and Public Health Institute, allschwill, Switzerland.
BMJ Glob Health. 2023 Apr;8(4). doi: 10.1136/bmjgh-2022-010934.
Coverage of antenatal iron and folic acid (IFA) supplementation and malaria chemoprophylaxis remains low in many low-income and middle-income settings. We assessed the effectiveness of personal information (INFO) sessions and personal information session plus home deliveries (INFO+DELIV) to increase coverage of IFA supplementation and intermittent preventive treatment in pregnancy (IPTp), and their effectiveness on postpartum anaemia and malaria infection.
We included 118 clusters randomised to a control (39), INFO (39) and INFO+DELIV (40) arm, in a trial conducted between 2020 and 2021 with pregnant women (age ≥15 years) in their first or second trimester of pregnancy in Taabo, Côte d'Ivoire. We used generalised linear regression models to assess intervention impact in postpartum anaemia and malaria parasitaemia, and displayed resulting estimates as prevalence ratios.
Overall, 767 pregnant women were enrolled and 716 (93.3%) were followed up after delivery. Neither intervention had an impact on postpartum anaemia, with estimated adjusted prevalence ratios (aPRs) of 0.97 (95% CI 0.79 to 1.19, p=0.770) for INFO and 0.87 (95% CI 0.70 to 1.09, p=0.235) for INFO+DELIV. While INFO had no effect on malaria parasitaemia (aPR=0.95, 95% CI 0.39 to 2.31, p=0.915), INFO+DELIV reduced malaria parasitaemia by 83% (aPR=0.17, 95% CI 0.04 to 0.75, p=0.019). No improvements in antenatal care (ANC) coverage (aPR=1.05, 95% CI 0.81 to 1.36, p=0.692), IFA (aPR=2.00, 95% CI 0.89 to 4.46, p=0.093) and IPTp (aPR=1.03, 95% CI 0.87 to 1.21, p=0.728) compliance were found for INFO. INFO+DELIV increased ANC attendance (aPR=1.35, 95% CI 1.02 to 1.78, p=0.037) and compliance with IPTp (aPR=1.60, 95% CI 1.41 to 1.80, p<0.001) and IFA recommendations (aPR=7.06, 95% CI 3.68 to 13.51, p<0.001).
INFO+DELIV can substantially increase compliance with IFA supplementation and improve malaria prevention. However, the increases in IFA supplementation are likely insufficient to address the prevalence of often severe anaemia in this population.
NCT04250428.
在许多低收入和中等收入国家，产前铁和叶酸（IFA）补充以及疟疾化学预防的覆盖率仍然很低。我们评估了个人信息（INFO）会议和个人信息会议加家庭分娩（INFO+DELIV）对增加 IFA 补充和间歇性预防治疗在怀孕中的覆盖率（IPT）的有效性，以及它们对产后贫血和疟疾感染的有效性。
我们在科特迪瓦 Taabo 进行的一项试验中，将 118 个集群随机分配到对照组（39 个）、INFO（39 个）和 INFO+DELIV（40 个）臂，参与者为年龄在 15 岁及以上的处于妊娠第一或第二阶段的孕妇。我们使用广义线性回归模型评估产后贫血和疟疾寄生虫血症的干预效果，并以患病率比（PR）显示结果估计值。
总体而言，共有 767 名孕妇入组，716 名（93.3%）在产后进行了随访。两种干预措施均未对产后贫血产生影响，INFO 的调整后患病率比（aPR）为 0.97（95%CI 0.79 至 1.19，p=0.770），INFO+DELIV 的 aPR 为 0.87（95%CI 0.70 至 1.09，p=0.235）。尽管 INFO 对疟疾寄生虫血症没有影响（aPR=0.95，95%CI 0.39 至 2.31，p=0.915），但 INFO+DELIV 可将疟疾寄生虫血症降低 83%（aPR=0.17，95%CI 0.04 至 0.75，p=0.019）。INFO 并未改善产前保健（ANC）覆盖率（aPR=1.05，95%CI 0.81 至 1.36，p=0.692）、IFA（aPR=2.00，95%CI 0.89 至 4.46，p=0.093）和 IPTp（aPR=1.03，95%CI 0.87 至 1.21，p=0.728）的依从性。INFO+DELIV 增加了 ANC 就诊率（aPR=1.35，95%CI 1.02 至 1.78，p=0.037）和 IPTp（aPR=1.60，95%CI 1.41 至 1.80，p<0.001）以及 IFA 建议（aPR=7.06，95%CI 3.68 至 13.51，p<0.001）的依从性。
INFO+DELIV 可以大大提高 IFA 补充的依从性并改善疟疾预防。然而，IFA 补充的增加可能不足以解决该人群中普遍存在的严重贫血问题。
NCT04250428。
