Prevalence of malaria parasitemia and purchase of artemisinin-based combination therapies (ACTs) among drug shop clients in two regions in Tanzania with ACT subsidies.
Prevalence of malaria parasitemia and purchase of artemisinin-based combination therapies (ACTs) among drug shop clients in two regions in Tanzania with ACT subsidies.
复制标题
疟疾寄生虫血症的患病率和坦桑尼亚两个地区的药店客户中基于青蒿素的组合疗法（使徒行为）的流行率。
DOI：
10.1371/journal.pone.0094074
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Kachur SP
中科院分区：
文献类型：
--
作者：
Briggs MA;Kalolella A;Bruxvoort K;Wiegand R;Lopez G;Festo C;Lyaruu P;Kenani M;Abdulla S;Goodman C;Kachur SP
在整个非洲，许多人在私营药店寻求疟疾治疗，而这些药店往往无法提供诊断检测。最近，坦桑尼亚的这些药店提供了基于青蒿素的联合疗法（ACT）的补贴，这是治疗无并发症疟疾的一线药物。本研究在国家 ACT 补贴计划和地方药店认证计划的背景下评估了药店客户的疟疾患病率和 ACT 购买情况。 2012 年 3 月至 5 月，在坦桑尼亚的两个地区（一个地区有政府药店认证计划，另一个地区没有政府药店认证计划）对药店客户进行了横断面调查。药店是从非城市地区随机抽样的。店员接受了有关他们的教育、培训和认证状况的采访。客户接受了有关他们的症状和药物购买情况的采访，然后接受了有限的体检和疟疾实验室检测。使用单变量分析和多元逻辑回归评估疟疾患病率和 ACT 购买的预测因素。在来自 73 家药店的 777 名顾客中，实验室确诊的疟疾患病率为 12%（95% CI：6-18%）。不到三分之一的疟疾患者购买了 ACT，不到四分之一的购买了 ACT 的患者疟疾检测呈阳性。如果参与者年龄 <5 岁（aOR：6.6；95% CI：3.9–11.0）或商店服务员有超过 5 年的经验（aOR：2.8；95% CI：1.2–6.3），则客户更有可能购买 ACT。在有药店认证计划的地区，患有疟疾只是购买 ACT 的一个预测因素（aOR：3.4；95% CI：1.5-7.4）。疟疾在因发烧而到药店就诊的人中很常见。疟疾患者购买 ACT 的比例较低，而向非疟疾患者购买 ACT 的比例较高，这表明需要更好地确定在这些药店接受 ACT 的人群。
Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6–18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9–11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2–6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5–7.4). Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops.
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