Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon
Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon
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DOI：
10.1111/j.1365-3156.2011.02918.x
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发表时间：
2012-03-01
影响因子：
3.3
通讯作者：
Mbacham, Wilfred F.
中科院分区：
文献类型：
--
作者：
Mangham, Lindsay J.;Cundill, Bonnie;Mbacham, Wilfred F.
目的了解喀麦隆采用青蒿素类联合治疗5年后疟疾病例管理质量。在不同类型的设施中检查了治疗模式，并调查了与处方或接受ACT相关的因素。方法在喀麦隆公立和私立卫生机构和药品零售商中所有年龄的个人中进行横断面聚类调查，这些人报告因发烧寻求治疗。疟疾的流行程度是通过快速诊断测试（RDTs）在医疗机构和药品零售商的同意患者中确定的。结果73%的患者开具或接受了抗疟药，51%的患者开具或接受了ACT。为患者提供的治疗因机构类型而有显著差异：65%的公立机构患者、55%的私立机构患者和45%的药品零售商患者开了处方或接受了ACT （P = 0.023）。对于要求ACT （or = 24.1, P < 0.001）、接受过卫生工作者检查（or = 1.88, P = 0.021）、此前未寻求过抗疟药物治疗（or = 2.29, P = 0.001）、在公立医院（or = 3.55）或私立医院（or = 1.99, P = 0.003）寻求治疗的发热患者，处方或接受ACT治疗的几率显著更高。29%的患者确诊患有疟疾，70%的阴性结果患者获得了抗疟药物处方或接受了治疗。结论疟疾病例管理有待改进。有症状的诊断效率低下，因为三分之二的发热病人没有疟疾。政府扩大疟疾检测的计划应促进合理使用青蒿素联合疗法；然而，在引入快速诊断检测的同时，需要更新临床指南，为检测结果阴性的患者的治疗提供明确指导。
Objective To investigate the quality of malaria case management in Cameroon 5 years after the adoption of artemisinin-based combination therapy (ACT). Treatment patterns were examined in different types of facility, and the factors associated with being prescribed or receiving an ACT were investigated. METHODS A cross-sectional cluster survey was conducted among individuals of all ages who left public and private health facilities and medicine retailers in Cameroon and who reported seeking treatment for a fever. Prevalence of malaria was determined by rapid diagnostic tests (RDTs) in consenting patients attending the facilities and medicine retailers. results Among the patients, 73% were prescribed or received an antimalarial, and 51% were prescribed or received an ACT. Treatment provided to patients significantly differed by type of facility: 65% of patients at public facilities, 55% of patients at private facilities and 45% of patients at medicine retailers were prescribed or received an ACT (P = 0.023). The odds of a febrile patient being prescribed or receiving an ACT were significantly higher for patients who asked for an ACT (OR = 24.1, P < 0.001), were examined by the health worker (OR = 1.88, P = 0.021), had not previously sought an antimalarial for the illness (OR = 2.29, P = 0.001) and sought treatment at a public (OR = 3.55) or private facility (OR = 1.99, P = 0.003). Malaria was confirmed in 29% of patients and 70% of patients with a negative result were prescribed or received an antimalarial. conclusions Malaria case management could be improved. Symptomatic diagnosis is inefficient because two-thirds of febrile patients do not have malaria. Government plans to extend malaria testing should promote rational use of ACT; though, the introduction of rapid diagnostic testing needs to be accompanied by updated clinical guidelines that provide clear guidance for the treatment of patients with negative test results.