Aung Poe Poe, Han Kay Thwe, Groot Wim, Biesma Regien, Thein Zaw Win, Htay Thura, Lin Zaw, Aye Kyin Hla, Adams Matthew, Pavlova Milena
Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
Trop Med Health. 2024 Mar 8;52(1):22. doi: 10.1186/s41182-024-00577-5.
Due to the low prevalence of clinically suspected malaria among pregnant women in Myanmar, little is known about its impact on mothers and newborns. Helminth and Human Immuno-deficiency Virus (HIV) co-infections cause anemia in pregnant women. This study assessed the prevalence of subclinical malaria and co-infections among pregnant women, and its association with adverse outcomes of pregnancy in the presence of infection.
A prospective longitudinal study was conducted in 12 villages in two townships in Myanmar between 2013 to 2015. A total of 752 pregnant women, with a mean age of 27 years, were enrolled and followed up once a month until six weeks after childbirth. Prevalence ratio was calculated in the multivariable analysis.
The prevalence of subclinical malaria as measured by nested PCR was 5.7% for either P. falciparum or P. vivax, 2.7% prevalence of P. falciparum and 2.8% prevalence of P. vivax. Helminth infections were prevalent in 17% of women, and one woman with an HIV infection was found in our study. The burden of anemia was high, with an overall prevalence of 37% with or without helminth infection, 42% of the women were malaria positive and 43% had dual infections (both malaria and helminth). Only 11 abnormal pregnancy outcomes (7 stillbirths, 2 premature, 2 twins) were identified. Poisson regression showed that women in their first trimester had a 2.9 times higher rate of subclinical malaria compared to women in the third trimester (PR:2.9, 95%CI 1.19, 7.31, p = 0.019), women who were enrolled during the wet season were 2.5 times more likely to be malaria positive than the women enrolled in the dry season (PR: 2.5, 95%CI 1.27, 4.88, p = 0.008), and the malaria positivity rate decreased by 5% when increased in one year of woman's age (PR:0.95, 95%CI 0.91, 0.99, p = 0.02). In the multivariable regression, the age of respondents was the only significant factor associated with subclinical malaria in pregnancy.
A comprehensive approach of integrating interventions for malaria, anemia, and helminths should be delivered during antenatal care services for pregnant women in rural areas of Myanmar.
由于缅甸孕妇中临床疑似疟疾的患病率较低，人们对其对母亲和新生儿的影响知之甚少。蠕虫感染和人类免疫缺陷病毒（HIV）合并感染会导致孕妇贫血。本研究评估了孕妇中亚临床疟疾和合并感染的患病率，以及感染情况下其与妊娠不良结局的关联。
2013年至2015年期间，在缅甸两个镇的12个村庄开展了一项前瞻性纵向研究。共纳入752名平均年龄为27岁的孕妇，每月随访一次，直至产后六周。在多变量分析中计算患病率比值。
通过巢式PCR检测，恶性疟原虫或间日疟原虫引起的亚临床疟疾患病率为5.7%，其中恶性疟原虫患病率为2.7%，间日疟原虫患病率为2.8%。17%的女性存在蠕虫感染，本研究中发现一名女性感染HIV。贫血负担较重，无论是否感染蠕虫，总体患病率为37%，42%的女性疟疾检测呈阳性，43%的女性存在双重感染（疟疾和蠕虫感染）。仅发现11例异常妊娠结局（7例死产、2例早产、2例双胞胎）。泊松回归显示，与孕晚期女性相比，孕早期女性亚临床疟疾发病率高2.9倍（PR：2.9，95%CI 1.19，7.31，p = 0.019），雨季入组的女性疟疾检测呈阳性的可能性是旱季入组女性的2.5倍（PR：2.5，95%CI 1.27，4.88，p = 0.008），女性年龄每增加一岁，疟疾阳性率下降5%（PR：0.95，95%CI 0.91，0.99，p = 0.02）。在多变量回归中，受访者年龄是与孕期亚临床疟疾相关的唯一显著因素。
对于缅甸农村地区的孕妇，应在产前护理服务中采用综合方法，对疟疾、贫血和蠕虫感染进行综合干预。
