Diagnosis of malaria in children's outpatient departments in Abuja, Nigeria
Diagnosis of malaria in children's outpatient departments in Abuja, Nigeria
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DOI：
10.1258/td.2008.080200
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发表时间：
2009-04-01
期刊：
影响因子：
0.6
通讯作者：
Whitty, Christopher J. M.
中科院分区：
文献类型：
--
作者：
Nomhwange, Terna I.;Whitty, Christopher J. M.
此前曾描述过疟疾的过度诊断，特别是在东非。阿布贾是非洲人口最多的国家的首都。在尼日利亚，以青蒿素为基础的联合疗法（ACT）抗疟药物的处方量与其他国家报告的规模相当，这将导致大量不必要地使用这类药物，在对阿布贾四个地区医院儿科门诊的1000名儿童进行的一项研究中，669名儿童有发热史，其中616名（92%）被诊断为疟疾。只有24例（3.8%）经疟疾切片阳性证实。在要求进行的82项疟疾检测中，有32项（40%）在临床医生开具处方时无法提供。在256名规定ACT的儿童中，11名（4.4%）测试阴性，8名（3.1%）测试阳性，11名（4.3%）测试不可用，219名（86%）未要求测试。接受抗疟药治疗的患者的可用阴性载玻片比例为23/26（88%），与接受抗疟药治疗的22/24（91%）检测阳性患者相似。疟疾检测对ACT处方或所有其他抗疟药和抗生素几乎没有影响。根据这些发现，抗疟药物处方大规模过量的可能性很高。
Over-diagnosis of malaria has previously been described, especially in East Africa. Abuja is the capital of the most populous country in Africa. Over-prescription of artemisinin-based combination therapy (ACT) antimalarials in Nigeria on the scale reported from other countries will result in substantial unnecessary use of this class of drug.In a study of 1000 children seen in the outpatient paediatric clinics of four district hospitals in Abuja, 669 had history of fever, of whom 616 (92%) were diagnosed with malaria. Only 24 (3.8%) where confirmed by positive malaria slides. Of 82 malaria tests requested, 32 (40%) were not available when clinicians wrote their prescriptions. Of 256 children prescribed an ACT, 11 (4.4%) were test negative, eight (3.1%) test positive, in 11 (4.3%) the test was not available and the test was not requested for 219 (86%). The proportion of available negative slides for patients treated with an antimalarial was 23/26 (88%), which was similar to the 22/24 (91%) treated with an antimalarial who were test positive. Testing for malaria made almost no impact on ACT prescription or on all other antimalarials and antibiotics. Based on these findings there is high possibility of massive over prescription of antimalarials.