Improving rational treatment of malaria: perceptions and influence of RDTs on prescribing behaviour of health workers in southeast Nigeria.
Improving rational treatment of malaria: perceptions and influence of RDTs on prescribing behaviour of health workers in southeast Nigeria.
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DOI：
10.1371/journal.pone.0014627
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发表时间：
2011-01-31
期刊：
影响因子：
3.7
通讯作者：
Sibeudu FT
中科院分区：
文献类型：
--
作者：
Uzochukwu BS;Onwujekwe E;Ezuma NN;Ezeoke OP;Ajuba MO;Sibeudu FT
快速诊断测试（RDTs）的发展为改进独立于显微镜诊断的远程疟疾诊断开辟了新的可能性。在某些情况下进行的研究试图评估RDTs对卫生工作者开处方行为的影响，但在尼日利亚和撒哈拉以南非洲的许多地区，这类信息普遍缺乏。本研究分析了卫生工作者对RDTs的看法，以及它们在引入RDTs后对其处方和治疗实践的潜在影响。这项研究是在尼日利亚埃努古州东埃努古地方政府的四个保健中心进行的。现场工作人员对部署了快速发展治疗的卫生中心的所有32名卫生工作者进行了访谈。寻求他们对基于症状、基于rdt和基于显微镜的疟疾诊断的看法的信息。此外，对400张处方进行处方分析，并在RDT部署前和部署后12个月进行处方分析。大多数卫生工作者认为，快速诊断疗法在疟疾诊断方面比显微镜和临床诊断更有效。他们还认为，就地就地治疗的好处包括在设施中更多地使用就地就地治疗，以及倾向于开出更多以青蒿素为基础的联合疗法（ACTs），而较少使用氯喹和SP。一些卫生工作者在使用就地就地治疗工具包的过程中遇到了一些困难。在rdt阴性结果中，有74%的患者开了ACTs。rdt支持的疟疾诊断可能导致以青蒿素为基础的联合疗法的过度处方，因为这种药物被开给了rdt阴性结果的人。然而，非一线药物的其他抗疟疾药物的处方已经减少。应努力鼓励卫生工作者相信RDT结果，只对RDT结果呈阳性的患者开以青蒿素为基础的联合疗法。需要进行深入研究，以确定为什么卫生工作者在rdt阴性结果中继续开以青蒿素为基础的联合疗法。
Developments in rapid diagnostic tests (RDTs) have opened new possibilities for improved remote malaria diagnosis that is independent of microscopic diagnosis. Studies in some settings have tried to assess the influence of RDTs on the prescribing behaviour of health workers, but such information is generally lacking in Nigeria and many parts of sub-Saharan Africa. This study analysed health workers' perceptions of RDTs and their potential influence on their prescribing and treatment practices after their introduction. The study was conducted in four health centers in the Enugu East local government of Enugu State, Nigeria. All 32 health workers in the health centers where RDTs were deployed were interviewed by field workers. Information was sought on their perception of symptoms-based, RDT-based, and microscopy-based malaria diagnoses. In addition, prescription analysis was carried out on 400 prescriptions before and 12 months after RDT deployment. The majority of the health workers perceived RDTs to be more effective for malaria diagnosis than microscopy and clinical diagnosis. They also felt that the benefits of RDTs included increased use of RDTs in the facilities and the tendency to prescribe more Artemisinin-based combination therapies (ACTs) and less chloroquine and SP. Some of the health workers experienced some difficulties in the process of using RDT kits. ACTs were prescribed in 74% of RDT-negative results. RDT-supported malaria diagnosis may have led to the overprescription of ACTs, with the drug being prescribed to people with RDT-negative results. However, the prescription of other antimalarial drugs that are not first-line drugs has been reduced. Efforts should be made to encourage health workers to trust RDT results and prescribe ACTs only to those with positive RDT results. In-depth studies are needed to determine why health workers continue to prescribe ACTs in RDT-negative results.
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影响因子：
7.7
作者：
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通讯作者：
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影响因子：
3
作者：
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影响因子：
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通讯作者：
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影响因子：
3.3
作者：
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通讯作者：
Greenwood, BM
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作者：
Reyburn, Hugh;Mbakilwa, Hilda;Whitty, Christopher J. M.
通讯作者：
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