Treatment of fevers prior to introducing rapid diagnostic tests for malaria in registered drug shops in Uganda.
Treatment of fevers prior to introducing rapid diagnostic tests for malaria in registered drug shops in Uganda.
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DOI：
10.1186/1475-2875-12-131
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发表时间：
2013-04-16
期刊：
影响因子：
3
通讯作者：
Magnussen P
中科院分区：
文献类型：
--
作者：
Mbonye AK;Lal S;Cundill B;Hansen KS;Clarke S;Magnussen P
由于药店在治疗发烧方面发挥着重要作用，在药店引入疟疾快速诊断检测（RDTs）可能有潜力将抗疟疾药物瞄准疟疾寄生虫患者，并改善合理用药。作为检验对乌干达药店适当治疗疟疾的影响以及对现行疟疾治疗政策指南遵守情况的整群随机试验的一部分，进行了一项调查，以估计疟疾适当治疗的基线患病率以及与之相关的因素，从而能够有效地设计和实施整群随机试验。2010年5月至9月在乌干达中部Mukono区的20个药店地理集群内进行了一项调查。一个集群被定义为一个教区，代表一群药店。使用两份结构化问卷收集数据：一份提供者问卷收集药店数据（n=65），包括提供者特征、疟疾治疗知识、以前接受的培训、库存药品类型、报告的药品销售情况和记录保存做法；以及一份患者问卷，以收集从药店出来的发热患者（n=540）关于出现症状、咨询过程、接受治疗和疟疾诊断的数据。研究小组通过显微镜检查血玻片以确定是否接受了适当的治疗，证实了药店摊贩作出的疟疾诊断。在药店看到的发热患者中，35%的RDT结果呈阳性，27%的血玻片呈阳性。许多患者（55%）在会诊前曾到另一家药店求医。在药店就诊的所有发热患者中，四分之三（73%）接受了抗疟药，其中39%接受了青蒿素类联合治疗，33%接受了奎宁。其余患者接受另一种非青蒿素单药治疗。只有三分之一（32%）的血玻片阳性患者接受了复方蒿甲醚治疗，而34%的血玻片阴性患者未接受抗疟疾药物治疗。总体而言，适当的治疗为34 (95% CI: 28 - 40)，集群间差异很大，范围从1%到55%。在这种情况下，在药店接受适当青蒿素联合疗法治疗的疟疾患者比例很低。这是由于假定治疗的做法、疟疾管理方面的培训不足以及缺乏对复方蒿甲醚®是推荐的疟疾一线治疗方法的认识。迫切需要采取干预措施，以改善这些出口的疟疾治疗。
Since drug shops play an important role in treatment of fever, introducing rapid diagnostic tests (RDTs) for malaria at drug shops may have the potential of targeting anti-malarial drugs to those with malaria parasites and improve rational drug use. As part of a cluster randomized trial to examine impact on appropriate treatment of malaria in drug shops in Uganda and adherence to current malaria treatment policy guidelines, a survey was conducted to estimate baseline prevalence of, and factors associated with, appropriate treatment of malaria to enable effective design and implementation of the cluster randomized trial. A survey was conducted within 20 geographical clusters of drug shops from May to September 2010 in Mukono district, central Uganda. A cluster was defined as a parish representing a cluster of drug shops. Data was collected using two structured questionnaires: a provider questionnaire to capture data on drug shops (n=65) including provider characteristics, knowledge on treatment of malaria, previous training received, type of drugs stocked, reported drug sales, and record keeping practices; and a patient questionnaire to capture data from febrile patients (n=540) exiting drug shops on presenting symptoms, the consultation process, treatment received, and malaria diagnoses. Malaria diagnosis made by drug shop vendors were confirmed by the study team through microscopy examination of a blood slide to ascertain whether appropriate treatment was received. Among febrile patients seen at drug shops, 35% had a positive RDT result and 27% had a positive blood slide. Many patients (55%) had previously sought care from another drug shop prior to this consultation. Three quarters (73%) of all febrile patients seen at drug shops received an anti-malarial, of whom 39% received an ACT and 33% received quinine. The rest received another non-artemisinin monotherapy. Only one third (32%) of patients with a positive blood slide had received treatment with Coartem® while 34% of those with a negative blood slide had not received an anti-malarial. Overall appropriate treatment was 34 (95% CI: 28 – 40) with substantial between-cluster variation, ranging from 1% to 55%. In this setting, the proportion of malaria patients receiving appropriate ACT treatment at drug shops was low. This was due to the practice of presumptive treatment, inadequate training on malaria management and lack of knowledge that Coartem® was the recommended first-line treatment for malaria. There is urgent need for interventions to improve treatment of malaria at these outlets.
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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
通讯作者：
Whitty CJ
DOI：
10.4269/ajtmh.2012.11-0791
发表时间：
2012-11-01
影响因子：
3.3
作者：
Awor, Phyllis;Wamani, Henry;Peterson, Stefan
通讯作者：
Peterson, Stefan
影响因子：
3.3
作者：
Mangham, Lindsay J.;Cundill, Bonnie;Mbacham, Wilfred F.
通讯作者：
Mbacham, Wilfred F.
影响因子：
3.7
作者：
Cohen J;Fink G;Berg K;Aber F;Jordan M;Maloney K;Dickens W
通讯作者：
Dickens W
影响因子：
1.5
作者：
Mbonye, A. K.;Bygbjerg, I. C.;Magnussen, P.
通讯作者：
Magnussen, P.