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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Intermittent preventive treatment of malaria during pregnancy in central Mozambique</title><author><name sortKey="Brentlinger, Paula E" sort="Brentlinger, Paula E" uniqKey="Brentlinger P" first="Paula E" last="Brentlinger">Paula E. Brentlinger</name><affiliation><nlm:aff id="aff1">Department of Health Services, School of Public Health and Community Medicine, PO Box 357660, University of Washington, Seattle, Washington 98195, USA.</nlm:aff></affiliation></author><author><name sortKey="Dgedge, Martinho" sort="Dgedge, Martinho" uniqKey="Dgedge M" first="Martinho" last="Dgedge">Martinho Dgedge</name><affiliation><nlm:aff id="aff2">Ministry of Health, Maputo, Mozambique.</nlm:aff></affiliation></author><author><name sortKey="Correia, Maria Ana Chadreque" sort="Correia, Maria Ana Chadreque" uniqKey="Correia M" first="Maria Ana Chadreque" last="Correia">Maria Ana Chadreque Correia</name><affiliation><nlm:aff id="aff3">Health Alliance International, Chimoio, Mozambique.</nlm:aff></affiliation></author><author><name sortKey="Rojas, Ana Judith Blanco" sort="Rojas, Ana Judith Blanco" uniqKey="Rojas A" first="Ana Judith Blanco" last="Rojas">Ana Judith Blanco Rojas</name><affiliation><nlm:aff id="aff4">Health Alliance International, Seattle, Washington, USA.</nlm:aff></affiliation></author><author><name sortKey="Saute, Francisco" sort="Saute, Francisco" uniqKey="Saute F" first="Francisco" last="Saúte">Francisco Saúte</name><affiliation><nlm:aff id="aff5">National Malaria Control Programme, Ministry of Health, Maputo, Mozambique.</nlm:aff></affiliation></author><author><name sortKey="Gimbel Sherr, Kenneth H" sort="Gimbel Sherr, Kenneth H" uniqKey="Gimbel Sherr K" first="Kenneth H" last="Gimbel-Sherr">Kenneth H. Gimbel-Sherr</name><affiliation><nlm:aff id="aff4">Health Alliance International, Seattle, Washington, USA.</nlm:aff></affiliation></author><author><name sortKey="Stubbs, Benjamin A" sort="Stubbs, Benjamin A" uniqKey="Stubbs B" first="Benjamin A" last="Stubbs">Benjamin A. Stubbs</name><affiliation><nlm:aff id="aff6">Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA.</nlm:aff></affiliation></author><author><name sortKey="Mercer, Mary Anne" sort="Mercer, Mary Anne" uniqKey="Mercer M" first="Mary Anne" last="Mercer">Mary Anne Mercer</name><affiliation><nlm:aff id="aff1">Department of Health Services, School of Public Health and Community Medicine, PO Box 357660, University of Washington, Seattle, Washington 98195, USA.</nlm:aff></affiliation></author><author><name sortKey="Gloyd, Stephen" sort="Gloyd, Stephen" uniqKey="Gloyd S" first="Stephen" last="Gloyd">Stephen Gloyd</name><affiliation><nlm:aff id="aff1">Department of Health Services, School of Public Health and Community Medicine, PO Box 357660, University of Washington, Seattle, Washington 98195, USA.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">18038078</idno><idno type="pmc">2636267</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636267</idno><idno type="RBID">PMC:2636267</idno><idno type="doi">10.2471/BLT.06.033381</idno><date when="2007">2007</date><idno type="wicri:Area/Pmc/Corpus">000E72</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000E72</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Intermittent preventive treatment of malaria during pregnancy in central Mozambique</title><author><name sortKey="Brentlinger, Paula E" sort="Brentlinger, Paula E" uniqKey="Brentlinger P" first="Paula E" last="Brentlinger">Paula E. Brentlinger</name><affiliation><nlm:aff id="aff1">Department of Health Services, School of Public Health and Community Medicine, PO Box 357660, University of Washington, Seattle, Washington 98195, USA.</nlm:aff></affiliation></author><author><name sortKey="Dgedge, Martinho" sort="Dgedge, Martinho" uniqKey="Dgedge M" first="Martinho" last="Dgedge">Martinho Dgedge</name><affiliation><nlm:aff id="aff2">Ministry of Health, Maputo, Mozambique.</nlm:aff></affiliation></author><author><name sortKey="Correia, Maria Ana Chadreque" sort="Correia, Maria Ana Chadreque" uniqKey="Correia M" first="Maria Ana Chadreque" last="Correia">Maria Ana Chadreque Correia</name><affiliation><nlm:aff id="aff3">Health Alliance International, Chimoio, Mozambique.</nlm:aff></affiliation></author><author><name sortKey="Rojas, Ana Judith Blanco" sort="Rojas, Ana Judith Blanco" uniqKey="Rojas A" first="Ana Judith Blanco" last="Rojas">Ana Judith Blanco Rojas</name><affiliation><nlm:aff id="aff4">Health Alliance International, Seattle, Washington, USA.</nlm:aff></affiliation></author><author><name sortKey="Saute, Francisco" sort="Saute, Francisco" uniqKey="Saute F" first="Francisco" last="Saúte">Francisco Saúte</name><affiliation><nlm:aff id="aff5">National Malaria Control Programme, Ministry of Health, Maputo, Mozambique.</nlm:aff></affiliation></author><author><name sortKey="Gimbel Sherr, Kenneth H" sort="Gimbel Sherr, Kenneth H" uniqKey="Gimbel Sherr K" first="Kenneth H" last="Gimbel-Sherr">Kenneth H. Gimbel-Sherr</name><affiliation><nlm:aff id="aff4">Health Alliance International, Seattle, Washington, USA.</nlm:aff></affiliation></author><author><name sortKey="Stubbs, Benjamin A" sort="Stubbs, Benjamin A" uniqKey="Stubbs B" first="Benjamin A" last="Stubbs">Benjamin A. Stubbs</name><affiliation><nlm:aff id="aff6">Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA.</nlm:aff></affiliation></author><author><name sortKey="Mercer, Mary Anne" sort="Mercer, Mary Anne" uniqKey="Mercer M" first="Mary Anne" last="Mercer">Mary Anne Mercer</name><affiliation><nlm:aff id="aff1">Department of Health Services, School of Public Health and Community Medicine, PO Box 357660, University of Washington, Seattle, Washington 98195, USA.</nlm:aff></affiliation></author><author><name sortKey="Gloyd, Stephen" sort="Gloyd, Stephen" uniqKey="Gloyd S" first="Stephen" last="Gloyd">Stephen Gloyd</name><affiliation><nlm:aff id="aff1">Department of Health Services, School of Public Health and Community Medicine, PO Box 357660, University of Washington, Seattle, Washington 98195, USA.</nlm:aff></affiliation></author></analytic><series><title level="j">Bulletin of the World Health Organization</title><idno type="ISSN">0042-9686</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><sec><title>Problem</title><p>New WHO strategies for control of malaria in pregnancy (MiP) recommend intermittent preventive treatment (IPTp), bednet use and improved case management.</p></sec><sec><title>Approach</title><p>A pilot MiP programme in Mozambique was designed to determine requirements for scale-up.</p></sec><sec><title>Local setting</title><p>The Ministry of Health worked with a nongovernmental organization and an academic institution to establish and monitor a pilot programme in two impoverished malaria-endemic districts.</p></sec><sec><title>Relevant changes</title><p>Implementing the pilot programme required provision of additional sulfadoxine-pyrimethamine (SP), materials for directly observed SP administration, bednets and a modified antenatal card. National-level formulary restrictions on SP needed to be waived. The original protocol required modification because imprecision in estimation of gestational age led to missed SP doses. Multiple incompatibilities with other health initiatives (including programmes for control of syphilis, anaemia and HIV) were discovered and overcome. Key outputs and impacts were measured; 92.5% of 7911 women received at least 1 dose of SP, with the mean number of SP doses received being 2.2. At the second antenatal visit, 13.5% of women used bednets. In subgroups (1167 for laboratory analyses; 2600 births), SP use was significantly associated with higher haemoglobin levels (10.9 g/dL if 3 doses, 10.3 if none), less malaria parasitaemia (prevalence 7.5% if 3 doses, 39.3% if none), and fewer low-birth-weight infants (7.3% if 3 doses, 12.5% if none).</p></sec><sec><title>Lessons learned</title><p>National-level scale-up will require attention to staffing, supplies, bednet availability, drug policy, gestational-age estimation and harmonization of vertical initiatives.</p></sec></div></front></TEI><pmc article-type="other" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Bull World Health Organ</journal-id><journal-id journal-id-type="publisher-id">BLT</journal-id><journal-title>Bulletin of the World Health Organization</journal-title><issn pub-type="ppub">0042-9686</issn><publisher><publisher-name>World Health Organization</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">18038078</article-id><article-id pub-id-type="pmc">2636267</article-id><article-id pub-id-type="doi">10.2471/BLT.06.033381</article-id><article-categories><subj-group subj-group-type="heading"><subject>Lessons from the Field</subject></subj-group></article-categories><title-group><article-title>Intermittent preventive treatment of malaria during pregnancy in central Mozambique</article-title><trans-title xml:lang="FR">Traitement préventif intermittent contre le paludisme des femmes enceintes dans le centre du Mozambique</trans-title><trans-title xml:lang="ES">Tratamiento preventivo intermitente de la malaria durante el embarazo en el centro de Mozambique</trans-title><trans-title xml:lang="AR">المعالجة الوقائية المتقطعة للملاريا أثناء الحمل في وسط موزمبيق</trans-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Brentlinger</surname><given-names>Paula E</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Dgedge</surname><given-names>Martinho</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Correia</surname><given-names>Maria Ana Chadreque</given-names></name><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rojas</surname><given-names>Ana Judith Blanco</given-names></name><xref ref-type="aff" rid="aff4"><sup>d</sup></xref></contrib><contrib contrib-type="author"><name><surname>Saúte</surname><given-names>Francisco</given-names></name><xref ref-type="aff" rid="aff5"><sup>e</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gimbel-Sherr</surname><given-names>Kenneth H</given-names></name><xref ref-type="aff" rid="aff4"><sup>d</sup></xref></contrib><contrib contrib-type="author"><name><surname>Stubbs</surname><given-names>Benjamin A</given-names></name><xref ref-type="aff" rid="aff6"><sup>f</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mercer</surname><given-names>Mary Anne</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gloyd</surname><given-names>Stephen</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><aff id="aff1"><label>a</label>Department of Health Services, School of Public Health and Community Medicine, PO Box 357660, University of Washington, Seattle, Washington 98195, USA.</aff><aff id="aff2"><label>b</label>Ministry of Health, Maputo, Mozambique.</aff><aff id="aff3"><label>c</label>Health Alliance International, Chimoio, Mozambique.</aff><aff id="aff4"><label>d</label>Health Alliance International, Seattle, Washington, USA.</aff><aff id="aff5"><label>e</label>National Malaria Control Programme, Ministry of Health, Maputo, Mozambique.</aff><aff id="aff6"><label>f</label>Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA.</aff></contrib-group><author-notes><corresp id="cor1">Correspondence to Paula E Brentlinger (e-mail: <email xlink:href="brentp2@u.washington.edu">brentp2@u.washington.edu</email>).</corresp></author-notes><pub-date pub-type="ppub"><month>11</month><year>2007</year></pub-date><volume>85</volume><issue>11</issue><fpage>873</fpage><lpage>879</lpage><history><date date-type="received"><day>22</day><month>5</month><year>2006</year></date><date date-type="rev-recd"><day>22</day><month>4</month><year>2007</year></date><date date-type="accepted"><day>30</day><month>4</month><year>2007</year></date></history><permissions><copyright-statement>© World Health Organization (WHO) 2007. All rights reserved.</copyright-statement><copyright-year>2007</copyright-year></permissions><abstract xml:lang="EN"><title>Abstract</title><sec><title>Problem</title><p>New WHO strategies for control of malaria in pregnancy (MiP) recommend intermittent preventive treatment (IPTp), bednet use and improved case management.</p></sec><sec><title>Approach</title><p>A pilot MiP programme in Mozambique was designed to determine requirements for scale-up.</p></sec><sec><title>Local setting</title><p>The Ministry of Health worked with a nongovernmental organization and an academic institution to establish and monitor a pilot programme in two impoverished malaria-endemic districts.</p></sec><sec><title>Relevant changes</title><p>Implementing the pilot programme required provision of additional sulfadoxine-pyrimethamine (SP), materials for directly observed SP administration, bednets and a modified antenatal card. National-level formulary restrictions on SP needed to be waived. The original protocol required modification because imprecision in estimation of gestational age led to missed SP doses. Multiple incompatibilities with other health initiatives (including programmes for control of syphilis, anaemia and HIV) were discovered and overcome. Key outputs and impacts were measured; 92.5% of 7911 women received at least 1 dose of SP, with the mean number of SP doses received being 2.2. At the second antenatal visit, 13.5% of women used bednets. In subgroups (1167 for laboratory analyses; 2600 births), SP use was significantly associated with higher haemoglobin levels (10.9 g/dL if 3 doses, 10.3 if none), less malaria parasitaemia (prevalence 7.5% if 3 doses, 39.3% if none), and fewer low-birth-weight infants (7.3% if 3 doses, 12.5% if none).</p></sec><sec><title>Lessons learned</title><p>National-level scale-up will require attention to staffing, supplies, bednet availability, drug policy, gestational-age estimation and harmonization of vertical initiatives.</p></sec></abstract><trans-abstract xml:lang="FR"><title>Résumé</title><sec><title>Problématique</title><p>Les nouvelles stratégies de l’OMS pour la lutte contre le paludisme pendant la grossesse préconisent un traitement antipaludique préventif intermittent, l’utilisation de moustiquaires de lit et une amélioration de la prise en charge des cas.</p></sec><sec><title>Démarche</title><p>Un programme pilote pour la Mozambique de lutte contre le paludisme pendant la grossesse a été conçu pour déterminer les besoins liés au passage à l’échelle supérieure.</p></sec><sec><title>Contexte local</title><p>Le ministère de la santé a collaboré avec une organisation non gouvernementale et un établissement d’enseignement supérieur dans la mise au point et le suivi d’un programme pilote appliqué dans deux districts appauvris d’endémie du paludisme.</p></sec><sec><title>Modifications pertinentes</title><p>Pour la mise en œuvre du programme pilote, il a fallu fournir une quantité supplémentaire de sulfadoxine-pyriméthamine (SP), du matériel pour l’administration sous surveillance directe de ce médicament et des moustiquaires. Il a également fallu modifier la fiche anténatale et obtenir une dérogation au guide national de prescription concernant la SP. Le protocole de départ a dû être modifié car l’imprécision dans l’évaluation de l’âge gestationnel conduisait à une prise incomplète des doses de SP. Plusieurs incompatibilités avec d’autres initiatives sanitaires (y compris des programmes de lutte contre la syphilis, l’anémie et le VIH) ont été découvertes et surmontées. Les principaux résultats et effets ont été mesurés : 92,5% des 7911 femmes enceintes ont reçu au moins une dose de SP, le nombre moyen de doses de SP reçues étant de 2,2. Lors de la deuxième visite anténatale, 13,5% des femmes utilisaient une moustiquaire de lit. Parmi les sous-groupes (1167 personnes pour les analyses en laboratoire, 2600 naissances), on a relevé une association significative entre l’utilisation de SP et une élévation du taux d’hémoglobine (10,9 g/dl pour la prise de 3 doses de SP contre 10,3 g/dl en l’absence de toute dose de SP), une baisse de la prévalence des parasites du paludisme (7,5% pour la prise de 3 doses contre 39,3% en l’absence de toute prise de SP) et une baisse de la proportion d’enfants de petit poids à la naissance (7,3% pour la prise de 3 doses contre 12,5% en cas l’absence de toute prise de SP).</p></sec><sec><title>Enseignements tirés</title><p>Le passage à l’échelle nationale du programme imposera de s’intéresser aux besoins en personnel, en fournitures et en moustiquaires, à la politique en matière de médicaments, à l’estimation de l’âge gestationnel et à l’harmonisation des initiatives verticales.</p></sec></trans-abstract><trans-abstract xml:lang="ES"><title>Resumen</title><sec><title>Problema</title><p>En las nuevas estrategias de la OMS para combatir la malaria durante el embarazo se recomienda el tratamiento preventivo intermitente, el uso de mosquiteros y una mejor gestión de los casos.</p></sec><sec><title>Enfoque</title><p>Se diseñó un programa piloto de control de la malaria en el embarazo en Mozambique a fin de determinar las condiciones necesarias para emprender una expansión masiva.</p></sec><sec><title>Entorno local</title><p>El Ministerio de Salud colaboró con una organización no gubernamental y una institución académica para establecer y seguir de cerca un programa piloto en dos distritos pobres con malaria endémica.</p></sec><sec><title>Cambios relevantes</title><p>La aplicación del programa piloto se basó en el suministro de sulfadoxina-pirimetamina (SP), material para la administración de SP bajo observación directa, mosquiteros y una tarjeta prenatal modificada. Fue necesario levantar las restricciones formales aplicables a nivel nacional a la SP, y hubo que modificar el protocolo original porque la imprecisión de las estimaciones de la edad gestacional conllevaba la omisión de dosis de SP. Se descubrieron y resolvieron numerosas incompatibilidades con otras iniciativas de salud (incluidos programas de control de la sífilis, la anemia y el VIH), y se midieron diversos resultados e impactos: el 92,5% de 7911 mujeres recibieron al menos una dosis de SP, y el número medio de dosis de SP recibidas fue de 2,2. En la segunda visita prenatal, el 13,5% de las mujeres usaban mosquiteros. Por subgrupos (1167 para análisis de laboratorio; 2600 nacimientos), el uso de SP se asoció de forma significativa a concentraciones de hemoglobina mayores (10,9 g/dl en caso de 3 dosis; 10,3 si no se había recibido ninguna dosis), una menor parasitemia malárica (prevalencia del 7,5% en caso de 3 dosis; 39,3% si no se había recibido ninguna dosis) y un menor número de lactantes con bajo peso al nacer (7,3% frente a 12,5% en caso de 3 o cero dosis, respectivamente).</p></sec><sec><title>Enseñanzas extraídas</title><p>Para extender masivamente las medidas de control a nivel nacional habrá que prestar atención al personal necesario, los suministros, la disponibilidad de mosquiteros, la política farmacéutica, la estimación de la edad gestacional y la armonización de las iniciativas verticales.</p></sec></trans-abstract><trans-abstract xml:lang="AR"><title>ملخص</title><sec><title>المشكلة</title><p>توصي الاستـراتيجيات الجديدة لمنظمة الصحة العالمية بشأن مكافحة الملاريا أثناء الحمل بإجراء معالجة وقائية متقطعة، واستخدام الناموسيات وتحسين التدبير العلاجي للحالات.</p></sec><sec><title>النەج</title><p>أُعِدَّ برنامج ارتيادي للمعالجة الوقائية المتقطعة للملاريا أثناء الحمل في موزمبيق بغرض تحديد المتطلبات اللازمة للنەوض بەذە المعالجة.</p></sec><sec><title>الإطار المحلي</title><p>عملت وزارة الصحة مع إحدى المنظمات غير الحكومية وأحد المعاەد الأكاديمية على إنشاء ورصد برنامج ارتيادي في مقاطعتَيْن فقيرتَيْن تتوطَّن فيەما الملاريا.</p></sec><sec><title>تغيُّرات ذات علاقة</title><p>تطلَّب تنفيذ البرنامج الارتيادي توفير كميات إضافية من عقار سلفادوكسين – بيريميثامين، ومواد لإعطاء ەذا العقار تحت المراقبة المباشرة، وناموسيات، وبطاقة معدَّلة للرعاية أثناء الحمل، مع الحاجة إلى التخلِّي عن قيود كتيِّب الوصفات الوطني حول السلفادوكسين – بيريميثامين. وتطلَّب البروتوكول الأصلي إجراء تعديل عليە بسبب مايؤديە عدم الدقة في تقدير العمر الحملي من تفويت لجرعات من ەذا العقار. واكتُشف العديد من جوانب عدم التوافق مع مبادرات صحية أخرى (بما يشمل برامج مكافحة الزەري، وفقر الدم وفيروس العوز المناعي البشري) وأمكن التغلُّب عليەا. وقيست النواتج والتأثيرات الأساسية، حيث تلقَّى 92.5% من 7911 سيدة جرعة واحدة على الأقل من سلفادوكسين – بيريميثامين، مع كون متوسط عدد الجرعات المتلقاة 2.2 جرعة. وفي الزيارة الثانية أثناء الحمل، استخدم 13.5% من ەؤلاء السيدات الناموسيات. وفي مجموعات فرعية (1167 سيدة خضعن للتحليلات المختبرية، 2600 ولادة) ارتبط استخدام السلفادوكسين – بيريميثامين ارتباطاً يعتد بە إحصائياً بوجود معدلات ەيموغلوبين أعلى (10.9 غ/دل إذا أخذت 3 جرعات و10.3 إذا لم تؤخذ أي جرعة) وانخفاض طفيليات الملاريا في الدم (معدل انتشار 7.5% إذا أخذت 3 جرعات و39.3% إذا لم تؤخذ أي جرعة) وعدد أقل من حالات انخفاض وزن الوليد عند ولادتە (7.3% إذا أخذت 3 جرعات و12.5% إذا لم تؤخذ أي جرعة).</p></sec><sec><title>الدروس المستفادة</title><p>يتطلَّب النەوض بەذە المعالجة على المستوى الوطني مزيداً من الاەتمام نحو توفير العاملين والإمدادات والناموسيات، ووجود سياسة دوائية، وتقدير للعمر الحملي، وتحقيق الانسجام بين المبادرات العمودية.</p></sec></trans-abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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