英国伦敦国王学院Cristina Fernandez Turienzo团队近日研究了以社区为基础的指导降低塞拉利昂青少年怀孕的孕产妇和围产期死亡率的效果。相关论文发表在2025年6月18日出版的《柳叶刀》杂志上。

塞拉利昂的孕产妇和新生儿死亡率非常高，其中很大一部分死亡发生在青少年中，这是一个特别脆弱的群体，通常是由贫困、缺乏教育和就业机会稀少造成的。该研究组评估了从怀孕到出生后1年的社区指导干预的可行性和潜在效果，为随后旨在降低青春期女孩及其新生儿死亡率的更大规模试验（(2YoungLives)）提供信息。

研究组在塞拉利昂5个地区的12个外围卫生单位提供服务的农村和城市社区开展了一项平行、试点、实施效果混合集群随机对照试验，将2YoungLives干预措施作为产妇护理的辅助措施。集群按1:1随机分配。所有年龄在18岁以下的怀孕少女都生活在这些聚集性社区并前来产科护理。主要结局是孕产妇和围产期死亡（包括死产和新生儿死亡）的综合结局，在所有随机分配的随访参与者中进行评估。该试验已前瞻性注册（ISRCTN32414369）。

2022年7月4日至2023年11月30日期间，673名女孩被纳入试验；6组共372名女孩被分配到2YoungLives干预组；361例纳入初级分析；6组301例（279例纳入初级分析）作为对照组。两组的随访损失均小于10%。干预组意向治疗的主要综合结局发生率显著降低（361例中有23例[6%]，对照组279例中有35例[13%]）。需要2YoungLives治疗以防止1例孕产妇或围产期死亡的人数为18人（95% CI 10 - 92）。

研究结果表明，“2YoungLives”是一项针对青春期少女从怀孕至出生后1年的社区指导干预措施，在塞拉利昂的城市和农村社区实施是可行的，并大大降低了孕产妇死亡、死产和新生儿死亡的综合数量。

附：英文原文

Title: Community-based mentoring to reduce maternal and perinatal mortality in adolescent pregnancies in Sierra Leone (2YoungLives): a pilot cluster-randomised controlled trial

Author: Cristina Fernandez Turienzo, Lucy November, Mangenda Kamara, Osman Conteh, Philemon Kamara, Appiah M Kingsford, Peter J S Koroma, Michael Munu, Alexandra E Ridout, Betty Sam, Paul T Seed, Suzanne Thomas, Prince T Williams, Andrew H Shennan, Jane Sandall, Adetunji Oladeni Adeniji, Patricia Bah, Candace Beoku-Betts, Harriet Boulding, Kate Bramham, Lucy C Chappell, Sahr Gevao, Venetia Goodhart, Mary Fullah, Rachel Hunter, Alice Hurrell, Sartie Kenneh, Katy Kuhrt, Andrew Leather, Chileshe Mabula-Bwalya, Margaret Mannah, Vincent Moghalu, Francis Moses, Sorie Samura, Mohamed Samai, Tom Sesay, Joan H Shepherd, Francis Smart, Francess Williams, Haja Ramatulai Wurie

Issue&Volume: 2025-06-18

Abstract:

Background

Sierra Leone has very high maternal and neonatal mortality rates, and a large proportion of these deaths occur in adolescents, a particularly vulnerable group, and is usually driven by poverty, lack of education, and sparse employment opportunities. We evaluated the feasibility and potential effects of a community-based mentoring intervention from pregnancy up to 1 year after birth to inform a subsequent larger trial aiming to reduce mortality among adolescent girls and their newborns (2YoungLives).

Methods

We conducted a parallel-arm, pilot, hybrid implementation–effectiveness cluster randomised controlled trial of the introduction of the 2YoungLives intervention as an adjunct to maternity care in rural and urban communities served by 12 peripheral health units in five districts of Sierra Leone. Clusters were randomly allocated 1:1. All pregnant adolescent girls aged younger than 18 years living in those cluster communities and presenting for maternity care were eligible. The primary outcome was a composite of maternal and perinatal deaths (including stillbirths and neonatal deaths), assessed in all randomly allocated participants who remained in follow-up. The trial was prospectively registered (ISRCTN32414369).

Findings

Between July 4, 2022, and Nov 30, 2023, 673 girls were included in the trial; six clusters with 372 girls were allocated to 2YoungLives (intervention group; 361 included in primary analysis) and six clusters with 301 girls were allocated to the control group (279 included in primary analysis). Loss to follow-up accounted for less than 10% in both groups. The incidence of the primary composite outcome by intention to treat was significantly lower in the intervention group (23 [6%] of 361 compared with 35 [13%] of 279 in the control group [adjusted risk ratio 0·52, 95% CI 0·34 to 0·81, p=0·0034; risk difference –0·05%, 95% CI –0·10 to –0·01]). The number needed to treat with 2YoungLives to prevent one maternal or perinatal death was 18 (95% CI 10 to 92).

Interpretation

2YoungLives, a community-based mentoring intervention for adolescent girls from pregnancy up to 1 year after birth, was feasible to implement in urban and rural communities in Sierra Leone and significantly reduced a composite of maternal deaths, stillbirths and neonatal deaths.

DOI: 10.1016/S0140-6736(25)00454-4

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00454-4/abstract