Treatment of paediatric malaria during a period of drug transition to artemether-lumefantrine in Zambia: cross sectional study
Treatment of paediatric malaria during a period of drug transition to artemether-lumefantrine in Zambia: cross sectional study
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DOI：
10.1136/bmj.331.7519.734
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发表时间：
2005-10-01
影响因子：
--
通讯作者：
Snow, RW
中科院分区：
文献类型：
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作者：
Zurovac, D;Ndhlovu, M;Snow, RW
目的评价氯喹替代磺胺嘧啶和蒿甲醚后无并发症疟疾的治疗方法。本芴醇在赞比亚。设计横断面调查。在赞比亚四个区的所有政府和使命设施设置门诊部。参与者944名儿童与103名卫生工作者在94个卫生设施就诊。主要结果措施抗疟处方在结果在94家机构中，蒿甲醚-苯芴醇、磺胺甲基嘧啶-乙胺嘧啶和氯喹分别有48家（51%）、94家（100%）和71家（76%）。在944名无并发症的疟疾儿童中，只有一名儿童（0.1%）接受了氯喹治疗。在体重低于10公斤的儿童中，通常根据指南开出周效磺胺-乙胺嘧啶（439/550，79.8%）。在体重10 kg或以上的儿童中，磺胺甲基嘧啶-乙胺嘧啶是常用处方（266/394，68%），而推荐的蒿甲醚-苯芴醇仅用于42/394（11%）儿童。在提供蒿甲醚-本芴醇的设施中看到的体重10公斤或以上的儿童中，观察到相同的模式：192名儿童中只有42名（22%）被开蒿甲醚-本芴醇处方，磺胺嘧啶-乙胺嘧啶仍然是首选药物（103/192，54%）。方案活动，如在职培训和提供工作aids似乎并没有影响处方的蒿甲醚-本芴醇。结论虽然使用氯喹的简单的疟疾是成功地停止在赞比亚，药物政策的变化对蒿甲醚-本芴醇并不一定转化为充分使用这种药物在护理点。
Objective To evaluate treatment practices for uncomplicated malaria after the policy change from chloroquine to sulfadoxine-pyrimediamine and to artemether-lumefantrine in Zambia.Design Cross sectional survey.Setting Outpatient departments of all government and mission facilities in four districts in Zambia.Participants 944 children with uncomplicated malaria seen by 103 health workers at 94 health facilities.Main outcome measures Antimalarial prescriptions in accordance with national guidelines and influence of factors on health workers' decision to prescribe artemether-lumefantrine.Results Artemether-lumefantrine, sulfadoxine-pyrimethamine, and chloroquine were available, respectively, at 48 (51%), 94 (100%), and 71 (76%) of the 94 facilities. Of 944 children with uncomplicated malaria, only one child (0.1%) received chloroquine. Among children weighing less than 10 kg, sulfadoxine-pyrimethamine was commonly prescribed in accordance with guidelines (439/550, 79.8%). Among the children weighing 10 kg or more, sulfadoxine-pyrimethamine was commonly prescribed (266/394,68%), whereas recommended artemether-lumefantrine was prescribed for only 42/394 (11%) children. Among children weighing 10 kg or more seen at facilities where artemether-lumefantrine was available, the same pattern was observed: artemether-lumefantrine was prescribed for only 42/192 (22%) children and sulfadoxine-pyrimethamine remained the drug of choice (103/192, 54%). Programmatic activities such as in-service training and provision of job aids did not seem to influence the prescribing of artemether-lumefantrine.Conclusion Although the use of chloroquine for uncomplicated malaria was succesfully discontinued in Zambia, the change of drug policy towards artemether-lumefantrine does not necessarily translate into adequate use of this drug at the point of care.