Integrated Community Case Management of Fever in Children under Five Using Rapid Diagnostic Tests and Respiratory Rate Counting: A Multi-Country Cluster Randomized Trial
Integrated Community Case Management of Fever in Children under Five Using Rapid Diagnostic Tests and Respiratory Rate Counting: A Multi-Country Cluster Randomized Trial
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DOI：
10.4269/ajtmh.2012.11-0816
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发表时间：
2012-11-01
影响因子：
3.3
通讯作者：
Pagnoni, Franco
中科院分区：
文献类型：
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作者：
Mukanga, David;Tiono, Alfred B.;Pagnoni, Franco
在发热儿童的社区病例管理中使用诊断性检测的影响的证据有限。这项在布基纳法索、加纳和乌干达进行的有效性试验比较了疟疾和肺炎的诊断和治疗包与抗疟疾药物的假定治疗;青蒿素联合疗法（ACT）。我们在2009-2010年招募了4，216名年龄在4至59个月之间的发热儿童。在这三个国家的干预组中，对疟疾快速诊断测试（RDT）结果的依从性很高，RDT阴性儿童中只有4.9%（344人中有17人）开了ACT。抗生素过度使用更为常见：乌干达为0.9%（4/446），布基纳法索为38.5%（114/296），加纳为44.6%（197/442）。在第3天（97.8% vs 96.9%，P = 0.17）和第7天（99.2% vs 98.8%，P = 0.17），干预组和对照组的发热清除率均较高。诊断检测的使用限制了ACT的过度使用。它对抗生素过度使用和发热清除的影响尚不确定。
Evidence on the impact of using diagnostic tests in community case management of febrile children is limited. This effectiveness trial conducted in Burkina Faso, Ghana, and Uganda, compared a diagnostic and treatment package for malaria and pneumonia with presumptive treatment with anti-malarial drugs; artemisinin combination therapy (ACT). We enrolled 4,216 febrile children between 4 and 59 months of age in 2009-2010. Compliance with the malaria rapid diagnostic test (RDT) results was high in the intervention arm across the three countries, with only 4.9% (17 of 344) of RDT-negative children prescribed an ACT. Antibiotic overuse was more common: 0.9% (4 of 446) in Uganda, 38.5% (114 of 296) in Burkina Faso, and 44.6% (197 of 442) in Ghana. Fever clearance was high in both intervention and control arms at both Day 3 (97.8% versus 96.9%, P = 0.17) and Day 7 (99.2% versus 98.8%, P = 0.17). The use of diagnostic tests limits overuse of ACTs. Its impact on antibiotic overuse and on fever clearance is uncertain.