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Child Health Outcomes After Presumptive Infection Treatment in Pregnant Women: A Randomized Trial.
Hallamaa, Lotta; Cheung, Yin Bun; Maleta, Kenneth; Luntamo, Mari; Ashorn, Ulla; Gladstone, Melissa; Kulmala, Teija; Mangani, Charles; Ashorn, Per.
Afiliação
  • Hallamaa L; Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; lotta.hallamaa@uta.fi.
  • Cheung YB; Center for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore.
  • Maleta K; Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
  • Luntamo M; Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
  • Ashorn U; Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
  • Gladstone M; Department of Neurodevelopmental Paediatrics, Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; and.
  • Kulmala T; Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
  • Mangani C; Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
  • Ashorn P; Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
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.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Infecciosas na Gravidez / Desenvolvimento Infantil / Saúde da Criança / Mortalidade da Criança Tipo de estudo: Clinical_trials / Incidence_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Child, preschool / Female / Humans / Infant / Pregnancy País/Região como assunto: Africa Idioma: En Revista: Pediatrics Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Infecciosas na Gravidez / Desenvolvimento Infantil / Saúde da Criança / Mortalidade da Criança Tipo de estudo: Clinical_trials / Incidence_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Child, preschool / Female / Humans / Infant / Pregnancy País/Região como assunto: Africa Idioma: En Revista: Pediatrics Ano de publicação: 2018 Tipo de documento: Article