Malaria case management in Papua New Guinea prior to the introduction of a revised treatment protocol.
Malaria case management in Papua New Guinea prior to the introduction of a revised treatment protocol.
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DOI：
10.1186/1475-2875-11-157
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发表时间：
2012-05-07
期刊：
影响因子：
3
通讯作者：
Hetzel MW
中科院分区：
文献类型：
--
作者：
Pulford J;Mueller I;Siba PM;Hetzel MW
本研究旨在记录巴布亚新几内亚在引入修订后的国家疟疾治疗方案之前的疟疾病例管理实践。修订后的方案规定通过快速诊断测试或显微镜检查对疟疾感染进行常规检测，仅对阳性病例开具抗疟疾处方，并引入一种新的基于青蒿素的一线抗疟药物。本文提出的研究结果主要集中于诊断、处方和治疗咨询实践。在对 79 个随机选择的卫生机构进行的全国横断面调查中，通过对出现发烧或近期发烧史的患者的临床病例管理进行非参与观察来收集数据。数据记录在结构化临床观察仪器上。总体而言，15% 的观察到的发热患者 (n = 468) 通过快速诊断测试进行了疟疾感染检测，另外 3.6% 通过显微镜进行了检测。 96.4%（451/468）的病例开出抗疟处方，其中检测阳性病例为100%（17/17），检测阴性病例为82%（41/50）。总的来说，79.8% 的抗疟疾处方符合数据收集时现行的治疗方案。 63.4% 的病例向患者解释了处方药物的用途，75.7% 的病例提供了剂量/方案说明，只有 1.1% 的病例讨论了不良反应的可能性及其可能的表现。如果要正确实施和遵守修订后的国家疟疾治疗方案，则需要对当前的临床实践进行重大改变。最需要改变的领域包括从推定诊断转向 RDT/显微镜确诊、向疟疾感染检测呈阴性的患者开具（或更确切地说，不开具）抗疟疾药物，以及提供彻底的治疗咨询。需要一项全面的临床医生支持计划，可能包括“加强”培训机会和定期临床监督来支持这一变革。
This study aimed to document malaria case management practices in Papua New Guinea prior to the introduction of a revised national malaria treatment protocol. The revised protocol stipulates routine testing of malaria infection by rapid diagnostic test or microscopy, anti-malarial prescription to test positive cases only, and the introduction of a new artemisinin-based first-line anti-malarial. Findings presented in this paper primarily focus on diagnostic, prescription and treatment counselling practices. In a national cross-sectional survey of 79 randomly selected health facilities, data were collected via non-participant observation of the clinical case management of patients presenting with fever or a recent history of fever. Data were recorded on a structured clinical observation instrument. Overall, 15% of observed fever patients (n = 468) were tested for malaria infection by rapid diagnostic test and a further 3.6% were tested via microscopy. An anti-malarial prescription was made in 96.4% (451/468) of cases, including 100% (17/17) of test positive cases and 82% (41/50) of test negative cases. In all, 79.8% of anti-malarial prescriptions conformed to the treatment protocol current at the time of data collection. The purpose of the prescribed medication was explained to patients in 63.4% of cases, dosage/regimen instructions were provided in 75.7% of cases and the possibility of adverse effects and what they might look like were discussed in only 1.1% of cases. The revised national malaria treatment protocol will require a substantial change in current clinical practice if it is to be correctly implemented and adhered to. Areas that will require the most change include the shift from presumptive to RDT/microscopy confirmed diagnosis, prescribing (or rather non-prescribing) of anti-malarials to patients who test negative for malaria infection, and the provision of thorough treatment counselling. A comprehensive clinician support programme, possibly inclusive of ‘booster’ training opportunities and regular clinical supervision will be needed to support the change.
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DOI：
10.1136/bmj.c930
发表时间：
2010-03-05
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Ansah EK;Narh-Bana S;Epokor M;Akanpigbiam S;Quartey AA;Gyapong J;Whitty CJ
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DOI：
10.4269/ajtmh.2007.77.947
发表时间：
2007-11-01
影响因子：
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