在实际项目环境中季节性疟疾化学预防对非疟疾儿科感染和常规抗生素使用的间接益处：一项使用阳性和阴性对照的前后对照研究

Indirect Benefits of Seasonal Malaria Chemoprevention for Non-Malarial Pediatric Infections and Routine Antibiotic Use in Real-World Programmatic Settings: A Pre-Post Study Using Positive and Negative Controls.

作者信息

Gebreegziabher Elisabeth A, Ouattara Mamadou, Bountogo Mamadou, Coulibaly Boubacar, Boudo Valentin, Ouedraogo Thierry, Lebas Elodie, Hu Huiyu, O'Brien Kieran S, Hsiang Michelle S, Glidden David V, Arnold Benjamin F, Lietman Thomas M, Sié Ali, Oldenburg Catherine E

机构信息

Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.

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

出版信息

medRxiv. 2025 May 9:2025.05.08.25327228. doi: 10.1101/2025.05.08.25327228.

DOI:10.1101/2025.05.08.25327228

PMID:40657315

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12248168/

Abstract

OBJECTIVE

To assess the benefits of Seasonal Malaria Chemoprevention (SMC), the monthly administration of sulfadoxine-pyrimethamine and amodiaquine during the high malaria season, beyond malaria prevention in real-world program settings.

METHODS

We conducted a pre-post comparison of non-malarial diagnoses (pneumonia, diarrhea, acute malnutrition) and antibiotic prescription rates during SMC administration weeks versus a three-week post-intervention period in rural Burkina Faso. Data came from clinic surveillance at 51 health facilities, a population-based census, and National Malaria Control Program data on SMC timing. Poisson regression models with person-weeks as an offset and standard errors clustered by health post estimated changes in rates. Interaction terms assessed variation across SMC cycles. Positive (malaria diagnoses, antimalarial prescriptions) and negative (injury) control outcomes were used to evaluate potential unmeasured confounding.

RESULTS

Compared to administration weeks, modest declines were observed in pneumonia, diarrhea, and acute malnutrition diagnoses, as well as in antibiotic prescription rates during the post-SMC period. Absolute reductions were 0.7 (95% CI: 0.3-1.0), 0.2 (95% CI: 0.1-0.4), 0.05 (95% CI: 0.001-0.09), and 0.90 (95% CI: 0.4-1.4) per 1,000 person-weeks, respectively. Positive control outcomes also declined, with malaria diagnoses and antimalarial prescriptions decreasing by 3.7 (95% CI: 2.6-4.8) and 3.6 (95% CI: 2.5-4.7) per 1,000 person-weeks. Injury rates (negative control) remained stable (0.02; 95% CI: -0.03 to 0.07). Reductions varied across SMC cycles and were most pronounced following the final round.

CONCLUSION

SMC may have additional benefits beyond malaria prevention, including reductions in common pediatric infections and subsequent routine antibiotic use.

摘要

目的

评估季节性疟疾化学预防（SMC）的益处，即在疟疾高发季节每月服用磺胺多辛-乙胺嘧啶和阿莫地喹，了解其在实际项目环境中除预防疟疾之外的其他效果。

方法

我们在布基纳法索农村地区，对SMC服药期与干预后三周内的非疟疾诊断（肺炎、腹泻、急性营养不良）情况及抗生素处方率进行了前后比较。数据来自51个医疗机构的临床监测、一项基于人群的普查以及国家疟疾控制项目关于SMC服药时间的数据。以人周数作为偏移量的泊松回归模型，并按卫生站对标准误差进行聚类，以估计发病率的变化。交互项评估了不同SMC周期之间的差异。使用阳性（疟疾诊断、抗疟药处方）和阴性（受伤）对照结果来评估潜在的未测量混杂因素。

结果

与服药期相比，SMC后时期的肺炎、腹泻和急性营养不良诊断以及抗生素处方率均出现适度下降。每1000人周的绝对降幅分别为0.7（95%置信区间：0.3 - 1.0）、0.2（95%置信区间：0.1 - 0.4）、0.05（95%置信区间：0.001 - 0.09）和0.90（95%置信区间：0.4 - 1.4）。阳性对照结果也有所下降，每1000人周的疟疾诊断和抗疟药处方分别减少3.7（95%置信区间：2.6 - 4.8）和3.6（95%置信区间：2.5 - 4.7）。受伤率（阴性对照）保持稳定（0.02；95%置信区间：-0.03至0.07）。不同SMC周期的降幅有所不同，在最后一轮后最为明显。