论文标题
撒哈拉以南非洲的疟疾负担变化与低出生体重之间的关系：通过双对方法的差异研究
Relationship between changing malaria burden and low birth weight in sub-Saharan Africa: a difference-in-differences study via a pair-of-pairs approach
论文作者
论文摘要
尽管介入性研究表明，预防怀孕期间的疟疾可以减轻低出生体重（即，儿童的出生体重$ <$ 2,500克），但尚不清楚寄生虫传播和疟疾负担的自然变化是否可以改善出生率。我们在2000年 - 2015年间，使用来自撒哈拉以南非洲1912个国家的1812个国家的1812个国家中的18,112个国家的数据来进行观察性研究，以改变疟疾负担对低出生体重的影响。疟疾患病率从高率（疟原虫寄生虫寄生虫率）下降（即2至10岁的儿童（即$ pf \ text {pr} _ {2-10} $> $ 0.4）到低率（$ pf \ text {pr} _ {2-10} _ {2-10}的汇率<$ <0.2） （95％置信区间：降低3.70个百分点，增加0.74个百分点），与观察到的出生体重记录（1.48/8.6 $ \ $ 17％）相比，低出生体重率降低了17％。当专注于第一次怀孕时，据估计，从高到低的疟疾患病率下降会对低出生体重率产生更大的影响：3.73个百分点（95％的置信区间：降低9.11个百分点，降低9.11个百分点，1.64个百分点增加）。尽管置信区间不能排除在95％置信度下无效的可能性，但我们的主要分析，次级分析和灵敏度分析以及效应大小的大小之间的同意有助于证据的重量，表明下降疟疾负担对人群水平的出生体重具有重要的影响。在本文中开发的新型统计方法，即对差异研究研究的对对的方法，对于许多在不同时间观察到的单元不同的环境可能是有用的。
Although interventional studies demonstrate that preventing malaria during pregnancy can reduce the low birth weight (i.e., child's birth weight $<$ 2,500 grams) rate, it remains unknown whether natural changes in parasite transmission and malaria burden can improve birth outcomes. We conduct an observational study of the effect of changing malaria burden on low birth weight using data from 18,112 births in 19 countries in sub-Saharan African countries during the years 2000--2015. A malaria prevalence decline from a high rate (Plasmodium falciparum parasite rate in children aged 2-up-to-10 (i.e., $Pf\text{PR}_{2-10}$) $>$ 0.4) to a low rate ($Pf\text{PR}_{2-10}$ $<$ 0.2) is estimated to reduce the rate of low birth weight by 1.48 percentage points (95% confidence interval: 3.70 percentage points reduction, 0.74 percentage points increase), which is a 17% reduction in the low birth weight rate compared to the average (8.6%) in our study population with observed birth weight records (1.48/8.6 $\approx$ 17%). When focusing on first pregnancies, a decline in malaria prevalence from high to low is estimated to have a greater impact on the low birth weight rate than for all births: 3.73 percentage points (95% confidence interval: 9.11 percentage points reduction, 1.64 percentage points increase). Although the confidence intervals cannot rule out the possibility of no effect at the 95% confidence level, the concurrence between our primary analysis, secondary analyses, and sensitivity analyses, and the magnitude of the effect size, contribute to the weight of the evidence suggesting that declining malaria burden has an important effect on birth weight at the population level. The novel statistical methodology developed in this article, a pair-of-pairs approach to a difference-in-differences study, could be useful for many settings in which the units observed are different at different times.
