Treatment-Seeking Behavior after the Implementation of a Unified Policy of Dihydroartemisinin-Piperaquine for the Treatment of Uncomplicated Malaria in Papua, Indonesia
Treatment-Seeking Behavior after the Implementation of a Unified Policy of Dihydroartemisinin-Piperaquine for the Treatment of Uncomplicated Malaria in Papua, Indonesia
复制标题
DOI：
10.4269/ajtmh.17-0680
复制
发表时间：
2018-01-01
影响因子：
3.3
通讯作者：
Yeung, Shunmay
中科院分区：
文献类型：
--
作者：
Devine, Angela;Kenangalem, Enny;Yeung, Shunmay
青蒿素联合疗法被推荐用于治疗多药耐药恶性疟原虫和间日疟原虫。2006年3月，印度尼西亚的抗疟政策改为用双氢青蒿素-哌喹统一治疗所有种类的疟疾，因为以前的药物治疗效果很低。2013年，在巴布亚进行了一项随机横断面家庭调查，以收集人口统计学、寄生虫阳性、寻求治疗行为、疟疾诊断和治疗以及家庭成本等数据。结果与2005年进行的类似调查进行了比较。2013年的调查共包括800个家庭，4，010人。疟疾寄生虫血症的患病率为12%（348/2，795）。在寻求发烧治疗的个人中，67%（66/98）报告至少去过一次公共服务提供者，而政策改变前为46%（349/764）（P < 0.001）。在100次访问医疗保健提供者期间，95%（95）包括疟疾血液检查，74%（64/86）导致诊断物种的推荐抗疟药，政策变化前的相应数字分别为48%（433/894）和23%（78/336）。多次寻求治疗的个人比例从政策改变前的14%（107/764）下降到政策改变后的2%（2/98）（P = 0.005）。需要寻求治疗的每次发热事件的平均间接成本从2005年的44.2美元降至2013年的33.8美元（P = 0.006）。实施高效抗疟治疗与公共和私营部门保健提供者更好地坚持治疗以及减少疟疾临床费用和家庭费用有关。
Artemisinin combination therapy is recommended for the treatment of multidrug resistant Plasmodium falciparum and Plasmodium vivax. In March 2006, antimalarial policy in Indonesia was changed to a unified treatment with dihydroartemisinin-piperaquine for all species of malaria because of the low efficacy of previous drug treatments. In 2013, a randomized cross-sectional household survey in Papua was used to collect data on demographics, parasite positivity, treatment-seeking behavior, diagnosis and treatment of malaria, and household costs. Results were compared with a similar survey undertaken in 2005. A total of 800 households with 4,010 individuals were included in the 2013 survey. The prevalence of malaria parasitemia was 12% (348/2,795). Of the individuals who sought treatment of fever, 67% (66/98) reported attending a public provider at least once compared with 46% (349/764) before policy change (P < 0.001). During the 100 visits to healthcare providers, 95% (95) included a blood test for malaria and 74% (64/86) resulted in the recommended antimalarial for the diagnosed species, the corresponding figures before policy change were 48% (433/894) and 23% (78/336). The proportion of individuals seeking treatment more than once fell from 14% (107/764) before policy change to 2% (2/98) after policy change (P = 0.005). The mean indirect cost per fever episode requiring treatment seeking decreased from US$44.2 in 2005 to US$33.8 in 2013 (P = 0.006). The implementation of a highly effective antimalarial treatment was associated with better adherence of healthcare providers in both the public and private sectors and a reduction in clinical malaria and household costs.