Carshon-Marsh Ronald, Di Ruggiero Erica
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5 T 3M7, Canada.
Malar J. 2025 Jun 10;24(1):185. doi: 10.1186/s12936-025-05429-z.
Malaria in pregnancy poses significant public health challenges with severe consequences for mothers, fetuses, and newborns. Despite the proven efficacy of insecticide-treated nets (ITNs), the coverage rate among pregnant women, lactating mothers and young children in sub-Saharan Africa remains suboptimal. For example, in Sierra Leone, only 52% of pregnant women and 50% of children under five years utilize ITNs. This coverage rate fell short of the national target, in which at least 80% of pregnant women are expected to report sleeping under an ITN. While considerable research has examined ITN access and usage in the general SSA population, focused implementation research on these high-risk groups in Sierra Leone is notably lacking. Addressing this gap is vital for enhancing intervention effectiveness and achieving sustained malaria control. The authors of this commentary recommend that further implementation research is needed to investigate the barriers and enabling factors to ITN adoption and utilization in pregnant women, lactating mothers and children under five years of age. Implementation research is crucial for understanding the gap between ITN access and actual use, enabling the design of effective and equitable interventions to boost utilization rates. Implementation research anchored in frameworks like Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) offers a pathway to decode these complexities, ensuring that global strategies resonate with local realities. By centering the voices of pregnant women, lactating mothers, and caregivers as well as addressing structural, cultural, and logistical barriers, Sierra Leone can transform ITN coverage into tangible reductions in malaria morbidity and mortality, advancing equity in its march toward elimination.
孕期疟疾给公共卫生带来了重大挑战，对母亲、胎儿和新生儿都会造成严重后果。尽管经杀虫剂处理的蚊帐（ITN）已被证明有效，但撒哈拉以南非洲地区孕妇、哺乳期母亲和幼儿的蚊帐覆盖率仍不理想。例如，在塞拉利昂，只有52%的孕妇和50%的五岁以下儿童使用经杀虫剂处理的蚊帐。这一覆盖率未达到国家目标，国家目标是至少80%的孕妇报告睡在经杀虫剂处理的蚊帐下。虽然已有大量研究调查了撒哈拉以南非洲地区普通人群获取和使用经杀虫剂处理的蚊帐的情况，但塞拉利昂针对这些高危人群的重点实施研究明显不足。填补这一空白对于提高干预效果和实现持续的疟疾控制至关重要。这篇评论文章的作者建议，需要进一步开展实施研究，以调查孕妇、哺乳期母亲和五岁以下儿童采用和使用经杀虫剂处理的蚊帐的障碍和促进因素。实施研究对于了解经杀虫剂处理的蚊帐的获取与实际使用之间的差距至关重要，有助于设计有效且公平的干预措施以提高使用率。基于“覆盖范围、有效性、采用率、实施情况和维持情况”（RE-AIM）等框架开展的实施研究提供了一条破解这些复杂问题的途径，确保全球战略与当地实际情况相契合。通过关注孕妇、哺乳期母亲和照料者的声音，并解决结构、文化和后勤方面的障碍，塞拉利昂可以将经杀虫剂处理的蚊帐覆盖率转化为疟疾发病率和死亡率的切实降低，在迈向消除疟疾的征程中推进公平。
