Improved diagnostic testing and malaria treatment practices in Zambia
Improved diagnostic testing and malaria treatment practices in Zambia
复制标题
DOI：
10.1001/jama.297.20.2227
复制
发表时间：
2007-05-23
影响因子：
120.7
通讯作者：
Snow, Robert W.
中科院分区：
文献类型：
--
作者：
Hamer, Davidson H.;Ndhlovu, Micky;Snow, Robert W.
背景提高疟疾诊断的准确性与快速抗原检测诊断测试（RDTs）已被提出作为一种方法，以减少疟疾的过度治疗，在当前时代的广泛实施青蒿素为基础的组合疗法在撒哈拉以南Africa.Objective评估之间的关联使用显微镜和RDT和抗疟药的处方。2006年3月至5月，在赞比亚4个哨点地区的政府和使命卫生设施中，在1个工作日内接受治疗的所有门诊病人中，进行疟疾诊断程序和接受抗疟治疗的病人比例。73%的人有一个或多个可用的诊断。在发热（疑似疟疾）患者中，27.8%（95%置信区间[CI]，13.1%-42.5%）在卫生机构接受疟疾诊断治疗，44.6%的患者检测结果呈阳性。在血涂片阴性的患者中，58.4%（95%CI，36.7%-80.2%）的患者接受了抗疟药物治疗，RDT阴性的患者中有35.5%（95%CI，16.0%-55.0%）接受了抗疟药物治疗。在没有进行诊断测试的发热患者中，65.9%的患者也接受了抗疟药物治疗。在有蒿甲醚-苯芴醇库存的设施中，这种抗疟药被开给大部分诊断试验结果呈阳性的发热患者（血涂片，75.0% [95%CI，51.7%-98.3%]; RDT，70.4% [95% CI，39.3%-100.0%]），但也适用于一些诊断试验结果阴性的患者（血涂片，30.4% [95%CI，8.0%-52.9%]; RDT，26.7% [95%CI，5.7%-47.7%]）。结论尽管赞比亚努力扩大疟疾诊断的提供，但它们仍然没有得到充分利用，检测结果阴性的患者经常接受抗疟药物治疗。在提供新的工具以减少不适当地使用新的昂贵的抗疟治疗方法的同时，还必须在对发烧但没有疟疾感染证据的病人的临床治疗方面作出重大改变。
Context Improving the accuracy of malaria diagnosis with rapid antigen-detection diagnostic tests (RDTs) has been proposed as an approach for reducing overtreatment of malaria in the current era of widespread implementation of artemisinin-based combination therapy in sub-Saharan Africa.Objective To assess the association between use of microscopy and RDT and the prescription of antimalarials.Design, Setting, and Participants Cross-sectional, cluster sample survey, carried out between March and May 2006, of all outpatients treated during 1 working day at government and mission health facilities in 4 sentinel districts in Zambia.Main Outcome Measure Proportions of patients undergoing malaria diagnostic procedures and receiving antimalarial treatment.Results Seventeen percent of the 104 health facilities surveyed had functional microscopy, 63% had RDTs available, and 73% had 1 or more diagnostics available. Of patients with fever (suspected malaria), 27.8% (95% confidence interval [CI], 13.1%-42.5%) treated in health facilities with malaria diagnostics were tested and 44.6% had positive test results. Of patients with negative blood smear results, 58.4% (95% CI, 36.7%-80.2%) were prescribed an antimalaria drug, as were 35.5% (95% CI, 16.0%-55.0%) of those with a negative RDT result. Of patients with fever who did not have diagnostic tests done, 65.9% were also prescribed antimalarials. In facilities with artemether-lumefantrine in stock, this antimalarial was prescribed to a large proportion of febrile patients with a positive diagnostic test result (blood smear, 75.0% [95% CI, 51.7%-98.3%]; RDT, 70.4% [95% CI, 39.3%-100.0%]), but also to some of those with a negative diagnostic test result (blood smear, 30.4% [95% CI, 8.0%-52.9%]; RDT, 26.7% [95% CI, 5.7%-47.7%]).Conclusions Despite efforts to expand the provision of malaria diagnostics in Zambia, they continue to be underused and patients with negative test results frequently receive antimalarials. Provision of new tools to reduce inappropriate use of new expensive antimalarial treatments must be accompanied by a major change in clinical treatment of patients presenting with fever but lacking evidence of malaria infection.