Challenges to implementation of artemisinin combination therapy policy in Uganda
Challenges to implementation of artemisinin combination therapy policy in Uganda
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DOI：
10.1016/j.inhe.2010.07.002
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发表时间：
2010-12-01
影响因子：
2.5
通讯作者：
Nuwaha, Fred
中科院分区：
文献类型：
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作者：
Batwala, Vincent;Magnussen, Pascal;Nuwaha, Fred
乌干达于2006年启动了青蒿素综合疗法政策，使用蒿甲醚-苯芴醇作为无并发症疟疾的一线治疗，但关于其执行情况的资料不足。对关键人员进行了半结构化访谈：来自Bushenyi和伊甘加区32个保健中心和卫生部的32名临床工作人员和4名实验室工作人员。与613名在6个随机选择的卫生中心接受疟疾治疗的患者进行了结构化访谈。收集了关于抗疟药物供应、治疗准则、工作人员配置和疟疾治疗决定的数据。临床工作人员的员额没有得到充分填补。只有15家（46.9%）HC在所有重量类别中储存了AL。在全国范围内，AL在2007年3月至7月期间缺货。21家（65.6%）卫生机构有氯喹库存。在193名患者中，177名（91.7%）在来到HC之前使用了除AL以外的抗疟药。不推荐的抗疟药主要来自私营营利部门，但没有关于私营营利部门提供抗疟药的指导方针。仅53/613例（8.6%）患者接受了寄生虫检查，仅8例（15.1%）血玻片阳性。大多数参加卫生保健的患者（560; 91.4%）接受抗疟药物，但只有323（57.7%）接受AL。应在包括私营部门筹资和伙伴关系部门在内的所有护理点提供足够数量的AL;应从市场上撤出非推荐药物，并应确保通过实验室诊断确认疟疾。研究注册：Clinicaltrials.gov NCT 00565071。(C)2010年皇家热带医学和卫生学会。由爱思唯尔有限公司出版。保留所有权利。
Uganda launched an artemisinin combination therapy (ACT) policy in 2006, using artemether-lumefantrine (AL) as first-line treatment for uncomplicated malaria, but insufficient information is available regarding its implementation. Semi-structured interviews were conducted with key personnel: 32 clinical and four laboratory staff from 32 health centres (HCs) in Bushenyi and Iganga districts and the Ministry of Health. Structured interviews with 613 patients receiving malaria treatment at six randomly chosen HCs were held. Data were collected on availability of antimalarials, treatment guidelines, staffing and malaria treatment decisions. Posts for clinical staff were inadequately filled. Only 15 (46.9%) HCs stocked AL for all weight categories. Nationwide, AL was out-of-stock March-July 2007. Twenty-one (65.6%) HCs stocked chloroquine. Out of 193 patients, 177 (91.7%) used antimalarials other than AL before coming to HCs. The unrecommended antimalarials were mainly sourced from the private for profit (PFP) sector yet there were no guidelines regarding provision of AL in the PFP sector. Only 53/613 (8.6%) patients were examined for parasites and only 8(15.1%) had a positive blood slide. The majority of the patients attending HCs (560; 91.4%) received antimalarials but only 323 (57.7%) received AL. In order to improve the implementation of the current policy. AL should be availed in adequate amounts at all points of care including the PFP sector; non-recommended drugs should be withdrawn from the market and it should be ensured that malaria is confirmed by laboratory diagnosis. Study registration: Clinicaltrials.gov NCT00565071. (C) 2010 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.