The impact of rapid malaria diagnostic tests upon anti-malarial sales in community pharmacies in Gwagwalada, Nigeria
The impact of rapid malaria diagnostic tests upon anti-malarial sales in community pharmacies in Gwagwalada, Nigeria
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DOI：
10.1186/1475-2875-12-380
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发表时间：
2013-10-30
期刊：
影响因子：
3
通讯作者：
Lalloo, David G.
中科院分区：
文献类型：
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作者：
Ikwuobe, John O.;Faragher, Brian E.;Lalloo, David G.
背景：疟疾快速诊断检测（RDT）已成为公共部门应对疟疾治疗前寄生虫学确诊挑战的一种切实可行的解决办法。然而，人们对它们对私营卫生部门设施，如药店和药店的影响知之甚少。本研究旨在评估在尼日利亚两家社区药房寻求抗疟疾治疗的不适患者的疟疾发病率，并衡量RDTs对抗疟疾药物销售的影响。方法：对2012年5月至7月期间位于尼日利亚联邦首都直辖区瓜瓦拉达郊区的两家药店进行比较研究。在干预组中，寻求购买抗疟疾药物的患者在治疗前进行RDT，而对照药房继续进行正常的常规操作。结果：共有1226名参与者被纳入研究。干预组（n = 619）的疟疾发病率为13.6%，青少年参与者的发病率（26.0%）高于成人（11.9%）（P = 0.001）。最近48小时有发热史与疟疾发病率增高有统计学意义（28.3%）（P < 0.001）。与不进行检测相比，进行RDT检测可使购买抗疟疾药物的机会减少42%（95%置信区间：38%-46%）。51.6%（276）的RDT阴性研究参与者仍然购买抗疟疾药物，特别是如果抗疟疾药物是由卫生专业人员推荐的（58.9%），而不是自我推荐（44.2%）（P = 0.001）。RDT结果阴性的患者如果就诊前报告疟疾实验室检测呈阳性（66.2%,P = 0.007），最近48小时内有发热史（60.5%,P = 0.027），小学及以下文化程度（69.4%,P = 0.009），也更有可能购买抗疟药。在调整了年龄组和性别差异后，与初等教育或更低教育程度的人相比，至少受过中学教育的人购买抗疟药的机会减少（OR 0.504 (95% CI: 0.256-0.993)）。结论：该研究强调了在改善药房抗疟疾药物处方和防止不必要使用青蒿素联合治疗（ACT）方面的巨大潜力。
Background: Rapid diagnostics tests for malaria (RDT) have become established as a practical solution to the challenges of parasitological confirmation of malaria before treatment in the public sector. However, little is known of their impact in private health sector facilities, such as pharmacies and drug shops. This study aimed to assess the incidence of malaria among unwell patients seeking anti-malarial treatment in two community pharmacies in Nigeria and measure the impact RDTs have on anti-malarial sales.Methods: This was a comparison study of two pharmacies located in the suburbs of Gwagwalada, in the Federal Capital Territory of Nigeria, between May and July 2012. In the intervention arm, patients seeking to purchase anti-malarials had an RDT performed before treatment while the control pharmacy continued normal routine practice.Results: A total of 1,226 participants were enrolled into the study. The incidence of malaria in the intervention arm (n = 619) was 13.6% and adolescent participants had a statistically significant higher incidence (26.0%) compared to adults (11.9%) (P = 0.001). A history of fever in the last 48 hours was associated with a statistically significant higher incidence of malaria (28.3%) (P < 0.001). Having a RDT test reduced the chance of purchasing an anti-malarial by 42% (95% CI: 38%-46%) compared to not having a test. 51.6% (276) of the study participants with a RDT negative result still purchased anti-malarials, especially if anti-malarials had been recommended by a health professional (58.9%) compared to self-referral (44.2%) (P = 0.001). Patients with RDT negative results were also more likely to purchase an anti-malarial if there was a reported malaria positive laboratory test prior to presentation (66.2%; P = 0.007), a history of fever in the last 48 hours (60.5%; P = 0.027), and primary school education or less (69.4%; P = 0.009). After adjusting for age group and gender differences, having at least a secondary school education reduced the chance of buying an anti-malarial (OR 0.504 (95% CI: 0.256-0.993)) compared to having primary education or lower.Conclusion: The study highlights the enormous potential for improving appropriate prescription of anti-malarials in pharmacies and preventing unnecessary use of artemisinin combination therapy (ACT).