Adherence to the combination of sulphadoxine-pyrimethamine and artesunate in the Maheba refugee settlement, Zambia
Adherence to the combination of sulphadoxine-pyrimethamine and artesunate in the Maheba refugee settlement, Zambia
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DOI：
10.1046/j.1365-3156.2003.01157.x
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发表时间：
2004-01-01
影响因子：
3.3
通讯作者：
Legros, D
中科院分区：
文献类型：
--
作者：
Depoortere, E;Guthmann, JP;Legros, D
基于青蒿素的联合疗法(ACT)是一种建议用于提高疟疾治愈率和遏制对恶性疟原虫耐药性的策略。在Maheba难民安置点，确诊为未合并恶性疟疾的5岁或5岁以下儿童接受磺胺乙胺(1天)和青蒿琥酯(3天)联合治疗。为了衡量治疗依从性，家访在最后一次治疗后的第二天进行。剩下任何治疗剂量的患者被认为肯定没有依从性。其他患者的分类是基于对问卷的回答：照顾者声称孩子完全按照处方接受了治疗方案的患者被认为可能是依从者；所有其他患者被认为可能不依从者。对不遵守的原因进行了评估。我们发现21.2%(95%CI[15.0-28.4])的患者肯定不黏附，39.4%(95%CI[31.6-47.6])可能不黏附，39.4%(95%CI[31.6-47.6])可能黏附。分配者的解释不足被认为是不遵守的一个重要原因。当考虑使用ACT时，患者依从性的问题仍然具有挑战性。然而，它不应被用作反对采用ACT的理由。为了使这些治疗方案长期有效，需要实施具体的和局部适应的战略，以确保完成治疗。
Artemisinin-based combination therapy (ACT) is one strategy recommended to increase cure rates in malaria and to contain resistance to Plasmodium falciparum. In the Maheba refugee settlement, children aged 5 years or younger with a confirmed diagnosis of uncomplicated falciparum malaria are treated with the combination of sulphadoxine-pyrimethamine (1 day) and artesunate (3 days). To measure treatment adherence, home visits were carried out the day after the last treatment dose. Patients who had any treatment dose left were considered certainly non-adherent. Other patients' classification was based on the answers to the questionnaire: patients whose caretakers stated the child had received the treatment regimen exactly as prescribed were considered probably adherent; all other patients were considered probably non-adherent. Reasons for non-adherence were assessed. We found 21.2% (95% CI [15.0-28.4]) of the patients to be certainly non-adherent, 39.4% (95% CI [31.6-47.6]) probably non-adherent, and 39.4% (95% CI [31.6-47.6]) probably adherent. Insufficient explanation by the dispenser was identified as an important reason for non-adherence. When considering the use of ACT, the issue of patient adherence remains challenging. However, it should not be used as an argument against the introduction of ACT. For these treatment regimens to remain efficacious on a long-term basis, specific and locally adapted strategies need to be implemented to ensure completion of the treatment.