Prescribing practice for malaria following introduction of artemether-lumefantrine in an urban area with declining endemicity in West Africa.
Prescribing practice for malaria following introduction of artemether-lumefantrine in an urban area with declining endemicity in West Africa.
复制标题
DOI：
10.1186/1475-2875-9-180
复制
发表时间：
2010-06-24
期刊：
影响因子：
3
通讯作者：
Walther M
中科院分区：
文献类型：
--
作者：
Okebe JU;Walther B;Bojang K;Drammeh S;Schellenberg D;Conway DJ;Walther M
疟疾的减少与新的、昂贵的抗疟疾药物的引入相吻合，促使人们对主要在东非的疟疾过度治疗进行研究。这里介绍的研究描述了在西非国家的卫生设施疟疾处方的做法。在冈比亚两个城市的初级卫生设施（PHFs）期间和以外的疟疾传播季节进行了横断面调查。设施在人员配备和进行载玻片显微镜检查的能力方面具有可比性。接受疟疾治疗的病人在接受咨询和血液涂片收集后登记，并在参考实验室进行阅读。将PHF的载玻片阅读结果与参考读数进行比较，并确定在参考实验室接受治疗但检测结果呈阴性的病例比例。33.2%（173例）的入组受试者提出了切片请求，在雨季，儿童（0 - 15岁）比成人更频繁（p = 0.003）。在同一时期，与年龄较大的儿童相比，五岁以下儿童的要求更常见（p = 0.022）;然而，后一组的阳性测试结果是4.4倍（p = 0.010）。在旱季和雨季，分别只有4.7%（10/215）和12.5%（37/297）的患者被证实患有寄生虫病。PHF玻片的阴性预测值在两个季节均保持在97%以上。这项研究提供了证据，表明西非地区的疟疾治疗过度，与东非疟疾传播率低的地区的报告相当。这些数据表明，实验室设施可能未得到充分利用，坚持PHF玻片阴性结果可以显着降低过度治疗的程度。5 - 15岁儿童的"发病高峰"可能反映了在5岁以下儿童中成功实施疟疾控制干预措施，但指出需要将此类干预措施扩大到年龄较大的儿童。
The decline in malaria coinciding with the introduction of newer, costly anti-malarials has prompted studies into the overtreatment for malaria mostly in East Africa. The study presented here describes prescribing practices for malaria at health facilities in a West African country. Cross-sectional surveys were carried out in two urban Gambian primary health facilities (PHFs) during and outside the malaria transmission season. Facilities were comparable in terms of the staffing compliment and capability to perform slide microscopy. Patients treated for malaria were enrolled after consultations and blood smears collected and read at a reference laboratory. Slide reading results from the PHFs were compared to the reference readings and the proportion of cases treated but with a negative test result at the reference laboratory was determined. Slide requests were made for 33.2% (173) of those enrolled, being more frequent in children (0-15 yrs) than adults during the wet season (p = 0.003). In the same period, requests were commoner in under-fives compared to older children (p = 0.022); however, a positive test result was 4.4 times more likely in the latter group (p = 0.010). Parasitaemia was confirmed for only 4.7% (10/215) and 12.5% (37/297) of patients in the dry and wet seasons, respectively. The negative predictive value of a PHF slide remained above 97% in both seasons. The study provides evidence for considerable overtreatment for malaria in a West African setting comparable to reports from areas with similar low malaria transmission in East Africa. The data suggest that laboratory facilities may be under-used, and that adherence to negative PHF slide results could significantly reduce the degree of overtreatment. The "peak prevalence" in 5-15 year olds may reflect successful implementation of malaria control interventions in under-fives, but point out the need to extend such interventions to older children.
登录
查看更多内容
DOI：
10.1016/j.trstmh.2008.10.003
发表时间：
2009-04-01
影响因子：
2.2
作者：
Drakeley, Chris;Reyburn, Hugh
通讯作者：
Reyburn, Hugh
影响因子：
3
作者：
Chandler, Clare I. R.;Jones, Caroline;Whitty, Christopher J. M.
通讯作者：
Whitty, Christopher J. M.
快速疟疾诊断测试对发烧患者治疗和健康结果的影响，桑给巴尔：一项跨界验证研究。
影响因子：
15.8
作者：
Msellem MI;Mårtensson A;Rotllant G;Bhattarai A;Strömberg J;Kahigwa E;Garcia M;Petzold M;Olumese P;Ali A;Björkman A
通讯作者：
Björkman A
影响因子：
3.3
作者：
Giao, PT;de Vries, PJ;Kager, PA
通讯作者：
Kager, PA
影响因子：
0.6
作者：
Nomhwange, Terna I.;Whitty, Christopher J. M.
通讯作者：
Whitty, Christopher J. M.