Urogenital schistosomiasis during pregnancy is associated with low birth weight delivery: analysis of a prospective cohort of pregnant women and their offspring in Gabon.

An estimated 40 million women of childbearing age suffer from schistosomiasis. Animal models indicate a deleterious effect of maternal schistosomiasis on pregnancy outcomes. To date there is a lack of epidemiological evidence evaluating schistosomiasis-related morbidity in pregnancy. This study was designed to describe the impact of urogenital schistosomiasis on pregnancy outcomes in a highly endemic region of central Africa. Pregnant women attending antenatal clinics in Fougamou and Lambaréné, Gabon, were consecutively screened for the presence of Schistosoma haematobium eggs in diurnal urine samples. Maternal and newborn characteristics assessed at delivery were compared between infected and uninfected mothers. The impact of maternal schistosomiasis on low birth weight and preterm delivery was assessed using logistic regression analysis. Urogenital schistosomiasis was diagnosed in 103 (9%) of 1115 pregnant women. Maternal age was inversely associated with the prevalence of urogenital schistosomiasis, with a higher burden amongst nulliparous women. Low birth weight was more common amongst infants of S. haematobium-infected mothers. This association was unaffected by controlling for demographic characteristics, gestational age and Plasmodium infection status (adjusted Odds Ratio 1.93; 95% confidence interval: 1.08-3.42). Other risk factors associated with low birth weight delivery were underweight mothers (adjusted Odds Ratio 2.34; 95% confidence interval: 1.12-4.92), peripheral or placental Plasmodium falciparum infection (adjusted Odds Ratio 2.04; 95% confidence interval: 1.18-3.53) and preterm birth (adjusted Odds Ratio 3.12; 95% confidence interval: 1.97-4.96). Preterm delivery was not associated with S. haematobium infection (adjusted Odds Ratio 1.07 95% confidence interval: 0.57-1.98). In conclusion, this study indicates that pregnant women with urogenital schistosomiasis are at an increased risk for low birth weight deliveries. Further studies evaluating targeted treatment and prevention programmes for urogenital schistosomiasis in pregnant women and their impact on delivery outcomes are warranted.

Formulacion e implantacion de politicas farmaceuticas: El caso de Chile / Pharmaceutical policies formulation and settlement: Chile's case

Se describe la politica farmaceutica vigente en Chile que acoge a la industria farmaceutica sin muchos obstaculos de importacion, fabricacion, precios y patentes. Se elaboran formas farmaceuticas a partir de principios activos de paises extranjeros que mueven aproximadamente 150 millones de dolares como inversion. la competencia generada y la libre comercializacion, respaldada por las politicas farmaceuticas pretende hacer mas accesible el medicamento. Se cuenta con un formulario nacional de medicamentos genericos y una lista de alternativas farmaceuticas de monodrogas comercializadas en el pais con un total de 653 principios activos y 2300 especialidades farmaceuticas. El consumo de medicamentos sigue el perfil de morbilidad nacional prevaleciendo el consumo de antibioticos, psicofarmacos, analgesicos y antiinflamatorios. Los precios son fijados libremente por los laboratorios, incrementados en un 20 por ciento por los mayoristas y un 25 a 35 por ciento por las farmacias. Se cuentan con medio para el uso racional de medicamentos