The impact of vector control interventions on adverse birth outcomes.

病媒控制干预措施对不良出生结局的影响。

• 批准号: 9900569
• 负责人: Michelle Roh
• 金额: $ 3.86万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9900569
• 关键词: Africa; Africa South of the Sahara; Area; Beds; Biometry; Birth; Case Study; Clinical; Cluster randomized trial; Communities; Competence; Control Groups; Country; Data; Effectiveness; Epidemiology; Evaluation; Future; Goals; Health; Infection; Insecticides; Interruption; Intervention; Investigation; Knowledge; Low Birth Weight Infant; Low Prevalence; Malaria; Malaria prevention; Maternal and Child Health; Mentorship; Methodology; Methods; Mission; Morbidity - disease rate; National Institute of Child Health and Human Development; Neonatal; Neonatal Mortality; Outcome; Parasites; Perinatal; Perinatal mortality demographics; Persons; Policies; Policy Maker; Pregnancy; Pregnant Women; Premature Birth; Public Health; Research; Research Design; Research Personnel; Residual state; Resistance; Risk; Sample Size; Study models; Time; Time Series Analysis; Training; Uganda; Universal Coverage; Woman; World Health Organization; base; career; cost; experimental study; fetal; global health; improved; insight; interdisciplinary approach; neonatal death; prevent; pyrethroid; scale up; skills; stillbirth; surveillance data; tool; vector; vector control

PROJECT SUMMARY In sub-Saharan Africa, infection with malaria parasites during pregnancy is estimated to be the cause of nearly 1 million low birth weight (LBW) babies, 220,000 stillbirths, and 110,000 neonatal deaths every year1-5. Vector control strategies, including long-lasting insecticide-treated bed nets (LLINs) and indoor residual spraying of insecticide (IRS) are powerful public health tools for malaria prevention, yet, their current impact on adverse birth outcomes is unknown. LLINs are recommended for all pregnant women in malaria-endemic Africa, but given widespread resistance to the pyrethroid class of insecticide used in LLINs, their efficacy may be waning. An alternative bed net, a pyrethroid-PBO LLIN, shows promise in replacing current LLINs. A recent modeling study showed pyrethroid-PBO LLINs may be highly effective, with the potential to avert up to 500 clinical malaria cases per 1000 person-years compared to standard (i.e. non PBO-treated) LLINs6. To evaluate the public health impact that pyrethroid-PBO LLINs may have for pregnant mothers, epidemiological evidence is needed to augment previous findings from modeling studies. IRS is another important public health strategy shown to be highly effective at reducing the burden of malaria7-12, but has traditionally been under-utilized due to high costs. Exploratory findings from our group suggest IRS is associated with reductions in LBW, preterm birth, and fetal/neonatal death13,14. However, whether IRS is an effective method of preventing malaria- associated adverse birth outcomes requires further evaluation using a more rigorous study design. The goal of this proposal is to investigate the effectiveness of current and new vector-control tools for preventing malaria-associated adverse birth outcomes. Uganda will be used as a case study for this proposal as the recent community distribution of IRS, standard LLINs, and pyrethroid-PBO LLINs provides a unique quasi-experimental opportunity to study these effects. The study will estimate the number of LBW and newborn deaths averted as a direct result of IRS (Aim 1) and standard LLINs (Aim 2a). The study will also assess whether pyrethroid-PBO LLINs confer a greater protective benefit than standard LLINs (Aim 2b). Analyses will use existing data, routinely collected by the Ministry of Health, and rigorous contemporary causal inference methods. The proposal will provide valuable and timely insight on whether existing vector-control strategies are effective or whether new LLINs to should be recommended for use in pregnant women over standard LLINs. Knowledge gained from this research will directly advance the NICHD’s mission of identifying interdisciplinary approaches that will reduce global perinatal deaths. The proposed training, guided by an exemplary mentorship team, will enhance the applicant’s methodological skills, research competency, and content expertise needed for her career as a future independent academic researcher focused on strategies to improve maternal and child health globally.

项目概要 在撒哈拉以南非洲地区，怀孕期间感染疟原虫估计是导致疟疾的原因 每年有近 100 万低出生体重 (LBW) 婴儿、22 万死产和 11 万新生儿死亡1-5。 病媒控制策略，包括长效杀虫剂处理的蚊帐 (LLIN) 和室内残留蚊帐 喷洒杀虫剂 (IRS) 是预防疟疾的有力公共卫生工具，但其目前对疟疾的影响 建议所有疟疾流行地区的孕妇使用 LLIN，不良分娩结果尚不清楚。 非洲，但鉴于对 LLIN 中使用的拟除虫菊酯类杀虫剂存在广泛耐药性，其功效可能 一种替代蚊帐，即拟除虫菊酯-PBO LLIN，有望取代目前的 LLIN。 模型研究表明拟除虫菊酯-PBO LLIN 可能非常有效，有可能避免多达 500 与标准（即未经 PBO 治疗的）LLIN 相比，每 1000 人年的临床疟疾病例数6。 拟除虫菊酯-PBO LLIN 对怀孕母亲可能产生的公共卫生影响、流行病学证据 需要补充之前的模型研究结果是另一项重要的公共卫生策略。 事实证明，它在减轻疟疾负担方面非常有效7-12，但由于传统上没有得到充分利用 我们小组的探索性发现表明 IRS 与 LBW、早产的减少有关。 出生和胎儿/新生儿死亡13,14 然而，IRS 是否是预防疟疾的有效方法- 相关的不良分娩结果需要使用更严格的研究设计进行进一步评估。 该提案的目标是研究当前和新的病媒控制的有效性 预防疟疾相关不良出生结果的工具将被用作案例研究。 该提案作为最近社区分发的 IRS、标准 LLIN 和拟除虫菊酯-PBO LLIN 提供 一个独特的准实验机会来研究这些影响。该研究将估计 LBW 和 LBW 的数量。 IRS（目标 1）和标准 LLIN（目标 2a）的直接结果是避免了新生儿死亡。 评估拟除虫菊酯-PBO LLIN 是否比标准 LLIN 具有更大的保护作用（目标 2b）。 分析将使用卫生部定期收集的现有数据以及严格的当代因果关系 该提案将为现有矢量控制是否存在提供有价值且及时的见解。 策略是否有效，或者是否应推荐新的 LLIN 用于孕妇 从这项研究中获得的知识将直接推进 NICHD 的识别使命。 拟议的培训以减少全球围产期死亡为指导。 模范导师团队，将提高申请人的方法论技能、研究能力和 作为未来的独立学术研究员，她的职业生涯所需的内容专业知识专注于战略 改善全球孕产妇和儿童健康。