An assessment of early diagnosis and treatment of malaria by village health volunteers in the Lao PDR.
An assessment of early diagnosis and treatment of malaria by village health volunteers in the Lao PDR.
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DOI：
10.1186/1475-2875-9-347
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发表时间：
2010-12-01
期刊：
影响因子：
3
通讯作者：
Barennes H
中科院分区：
文献类型：
--
作者：
Phommanivong V;Thongkham K;Deyer G;Rene JP;Barennes H
早期诊断和治疗对于减轻低收入国家的疟疾负担至关重要。在老挝人民民主共和国，这一战略于2004-2005年推出，并于2007年1月在社区一级进行了评估。在老挝6个疟疾流行省份（3个试点省份（PP）和3个非试点省份（NPP））的36名随机乡村卫生志愿者（VHV）和720名患者中前瞻性评估了疟疾快速诊断试验（MRDT）和青蒿素联合治疗（ACT）的EDAT。ACT还回顾性评估了2188例患者在同一地区从2006年6月至11月。使用两个检查表并计算评分。PP中VHV的EDAT性能优于NPP（分别为16.67%和38.89%，p = 0.004）。几乎所有的VHV都可以诊断疟疾，但只有16个（44%）可以描述严重疟疾的症状。2007年1月，31/720（4%）例患者使用Paracheck®检测呈阳性，35（5%）例患者使用显微镜检测呈阳性（灵敏度：74.3%，特异性99.3%，阳性和阴性预测值：分别为83.9%和98.7%）。6 ~ 11月发热患者疟疾发病率较高，2,188例发热患者中疟疾阳性率为35.19%（OR：10.6，95%CI：7.4-15.5，p < 0.000）。VHV报告MRDT易于使用，并获得了令人满意的性能评分。尽管ACT治疗、持续时间和剂量方面的结果令人满意，但EDAT性能被评为较差。严重疟疾的转诊前治疗很少，而且往往不足，其中20%的患者死亡。结果表明，严重疟疾的死亡率高于官方报告的死亡率。ACT短缺是经常发生的。MRDT和ACT是有用和有效的，可供VHV使用。通过培训和监测，提高了高危车辆的全球EDAT性能。必须解决在知识、病人护理和错误治疗方面持续存在的差距。
Early diagnosis and treatment (EDAT) is crucial to reducing the burden of malaria in low-income countries. In the Lao PDR, this strategy was introduced in 2004-2005 and an assessment was performed at the community level in January 2007. EDAT with malaria rapid diagnostic test (MRDT) and artemisinin combination therapy (ACT) was prospectively assessed among 36 randomized village health volunteers (VHVs) and 720 patients in six malaria-endemic provinces of Laos (three pilot provinces (PP), and three non-pilots provinces (NPP)). ACT was also retrospectively assessed among 2188 patients within the same areas from June to November 2006. Two checklists were used and scores were calculated. EDAT performance of the VHVs was rated better in PP than in NPP (16.67% versus 38.89%, respectively, p = 0.004). Nearly all VHVs could diagnose malaria but only 16 (44%) could describe the symptoms of severe malaria. In January 2007, 31/720 (4%) patients tested positive using the Paracheck® test, 35 (5%) with microscopy (sensibility: 74.3%, specificity 99.3%, positive and negative predictive values: 83.9% and 98.7%, respectively). Patients from June to November were at higher risk of malaria: 35.19% of 2,188 febrile patients were positive (OR: 10.6, 95%CI: 7.4-15.5, p < 0.000). VHVs reported the MRDT easy to use, and yielded a satisfactory performance score. EDAT performance was rated as poor despite satisfactory results regarding ACT treatment, duration and dosages. Pre-referral treatment of severe malaria was infrequent and often inadequate, with 20% of these patients dying. Results suggest a higher mortality from severe malaria than officially reported. Shortage of ACT was frequent. MRDT and ACT are useful and efficient and can be used by VHVs. VHVs' global EDAT performance is enhanced through training and monitoring. Persistent gaps in knowledge, care of patients and wrong treatment have to be addressed.
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DOI：
10.1016/j.trstmh.2004.08.007
发表时间：
2005-06-01
影响因子：
2.2
作者：
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影响因子：
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发表时间：
2006-07-01
影响因子：
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DOI：
10.1016/j.trstmh.2005.06.012
发表时间：
2005-11-01
影响因子：
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