Child Health Outcomes After Presumptive Infection Treatment in Pregnant Women: A Randomized Trial.
Pediatrics
; 141(3)2018 03.
Article
em En
| MEDLINE
| ID: mdl-29472491
BACKGROUND AND OBJECTIVES: We showed earlier that presumptive infection treatment in pregnancy reduced the prevalence of neonatal stunting in a rural low-income setting. In this article, we assess how these gains were sustained and reflected in childhood growth, development, and mortality. METHODS: We enrolled 1320 pregnant Malawian women in a randomized trial and treated them for malaria and other infections with either 2 doses of sulfadoxine-pyrimethamine (SP) (control), monthly SP, or monthly sulfadoxine-pyrimethamine and 2 doses of azithromycin (AZI-SP). Child height or length and mortality were recorded at 1, 6, 12, 24, 36, 48, and 60 months and development at 60 months by using Griffith's Mental Development Scales. RESULTS: Throughout follow-up, the mean child length was 0.4 to 0.7 cm higher (P < .05 at 1-12 months), the prevalence of stunting was 6 to 11 percentage points lower (P < .05 at 12-36 months), and the 5-year cumulative incidence of stunting was 13 percentage points lower (hazard ratio: 0.70, 95% confidence interval [CI]: 0.60 to 0.83, P < .001) in the AZI-SP group than in the control group. The mean developmental score was 3.8 points higher in the AZI-SP group than in the control group (95% CI: 1.1 to 6.4, P = .005). Total mortality during pregnancy and childhood was 15.3%, 15.1%, and 13.1% (P = .60) in the control, monthly SP, and AZI-SP groups, respectively. Postneonatal mortality (secondary outcome) was 5.5%, 3.3%, and 1.9%, respectively (risk ratio of AZI-SP versus control: 0.34, 95% CI: 0.15 to 0.76, P = .008). CONCLUSIONS: Provision of AZI-SP rather than 2 doses of SP during pregnancy reduced the incidence of stunting in childhood. AZI-SP during pregnancy also had a positive effect on child development and may have reduced postneonatal mortality.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Infecciosas na Gravidez
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Desenvolvimento Infantil
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Saúde da Criança
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Mortalidade da Criança
Tipo de estudo:
Clinical_trials
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Incidence_studies
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Observational_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Child, preschool
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Female
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Humans
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Infant
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Pregnancy
País/Região como assunto:
Africa
Idioma:
En
Revista:
Pediatrics
Ano de publicação:
2018
Tipo de documento:
Article