Health workers' compliance to rapid diagnostic tests (RDTs) to guide malaria treatment: a systematic review and meta-analysis
Health workers' compliance to rapid diagnostic tests (RDTs) to guide malaria treatment: a systematic review and meta-analysis
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DOI：
10.1186/s12936-016-1218-5
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发表时间：
2016-03-15
期刊：
影响因子：
3
通讯作者：
van Vugt, Michele
中科院分区：
文献类型：
--
作者：
Kabaghe, Alinune N.;Visser, Benjamin J.;van Vugt, Michele
背景：世界卫生组织建议在治疗前通过显微镜检查或快速诊断试验（RDT）确诊疟疾。在资源有限的情况下，正确使用RDTs有助于根据确诊进行治疗；有助于加快考虑正确的替代诊断，防止抗疟疾药物的过度处方，降低成本并避免不必要的药物不良反应。本综述旨在评估卫生工作者对RDT结果的依从性以及促成依从性的因素。方法：根据系统评价和荟萃分析（PRISMA）指南的首选报告项目，进行了一项普洛斯罗注册的系统评价，以评估撒哈拉以南非洲地区卫生工作者对RDTs的依从性。在Medline/Ovid、Embase、Cochrane Central Register of Controlled Trials、Web of Science、LILACS、Biosis Previews和African Index Medicus中检索截至2015年11月发表的研究，不受语言限制。主要结局是卫生工作者根据获得的RDT结果治疗患者。结果：文献检索共发现474篇报告；14项研究符合条件并纳入定量分析。从荟萃分析来看，卫生工作者在开始治疗或不按照各自的RDT结果进行治疗方面的总体依从性为83% （95% CI 80- 86%）。阳性和阴性结果的依从性分别为97% （95% CI 94- 99%）和78% （95% CI 66- 89%）。社区卫生工作者对阴性检测结果的依从率高于临床医生。患者的期望、工作经验、对结果的怀疑、卫生工作者的干部和对测试有效性的感知影响了依从性。结论：根据公布的数据，撒哈拉以南非洲地区对RDT的依从性总体上是公平的；需要改进对阴性结果的依从性，以防止对患者的管理不当和抗疟疾药物的过量处方。提高对其他发热性疾病的诊断能力和制定当地循证指南可能有助于改善RDT阴性结果的依从性和管理。
Background: The World Health Organization recommends malaria to be confirmed by either microscopy or a rapid diagnostic test (RDT) before treatment. The correct use of RDTs in resource-limited settings facilitates basing treatment onto a confirmed diagnosis; contributes to speeding up considering a correct alternative diagnosis, and prevents overprescription of anti-malarial drugs, reduces costs and avoids unnecessary exposure to adverse drug effects. This review aims to evaluate health workers' compliance to RDT results and factors contributing to compliance.Methods: A PROSPERO-registered systematic review was conducted to evaluate health workers' compliance to RDTs in sub-Saharan Africa, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published up to November 2015 were searched without language restrictions in Medline/Ovid, Embase, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, Biosis Previews and the African Index Medicus. The primary outcome was health workers treating patients according to the RDT results obtained.Results: The literature search identified 474 reports; 14 studies were eligible and included in the quantitative analysis. From the meta-analysis, health workers' overall compliance in terms of initiating treatment or not in accordance with the respective RDT results was 83 % (95 % CI 80-86 %). Compliance to positive and negative results was 97 % (95 % CI 94-99 %) and 78 % (95 % CI 66-89 %), respectively. Community health workers had higher compliance rates to negative test results than clinicians. Patient expectations, work experience, scepticism of results, health workers' cadres and perceived effectiveness of the test, influenced compliance.Conclusions: With regard to published data, compliance to RDT appears to be generally fair in sub-Saharan Africa; compliance to negative results will need to improve to prevent mismanagement of patients and overprescribing of anti-malarial drugs. Improving diagnostic capacity for other febrile illnesses and developing local evidence-based guidelines may help improve compliance and management of negative RDT results.