Monitoring fever treatment behaviour and equitable access to effective medicines in the context of initiatives to improve ACT access: baseline results and implications for programming in six African countries
Monitoring fever treatment behaviour and equitable access to effective medicines in the context of initiatives to improve ACT access: baseline results and implications for programming in six African countries
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DOI：
10.1186/1475-2875-10-327
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发表时间：
2011-10-31
期刊：
影响因子：
3
通讯作者：
O'Connell, Kathryn A.
中科院分区：
文献类型：
--
作者：
Littrell, Megan;Gatakaa, Hellen;O'Connell, Kathryn A.
背景：在疟疾负担高的国家，获得基于青蒿素的联合疗法（ACT）仍然有限，并且人们担心最贫困的人群处于特别不利的地位。本文提供了六个非洲国家家庭寻求治疗行为的新证据。这些数据为监测干预措施提供了基线，以提高 ACT 覆盖率，例如疟疾平价药物基金 (AMFm)。方法：2008 年至 2010 年间，在贝宁、刚果民主共和国 (DRC)、马达加斯加、尼日利亚、乌干达和赞比亚进行了具有全国代表性的家庭调查。护理人员回答了有关五岁以下儿童近期发烧管理的问题。将各国的治疗指标制成表格，并使用卡方检验检查公共部门与私营部门提供的病例管理的差异。使用逻辑回归来检验社会经济状况与 1) 疟疾血液检测和 2) ACT 治疗之间的关联。结果：贝宁 (10%)、刚果民主共和国 (5%)、马达加斯加 (3%) 和尼日利亚 (5%) 的 ACT 治疗发烧率较低，但乌干达 (21%) 和赞比亚 (21%) 较高。在贝宁，最富有的儿童比最贫穷的儿童更有可能接受 ACT（OR = 2.68，95% CI = 1.12-6.42）； DRC（OR = 2.18，95% CI = 1.12-4.24）；马达加斯加（OR = 5.37，95% CI = 1.58-18.24）；和尼日利亚（OR = 6.59，95% CI = 2.73-15.89）。大多数护理人员在家庭之外寻求治疗，私营部门通常是唯一的外部治疗来源（赞比亚除外）。然而，在公共部门接受治疗的儿童比在私营部门接受治疗的儿童更有可能接受 ACT 治疗（马达加斯加除外）。尽管如此，公共部门的检测和 ACT 治疗水平仍然较低。在马达加斯加 (2%)、刚果民主共和国 (2%)、尼日利亚 (4%) 和贝宁 (10%)，很少有护理人员认为这种国家一线药物治疗疟疾最有效。赞比亚 (49%) 和乌干达 (33%) 的意识较高。结论：在许多情况下，有效的发烧治疗水平较低且不公平。私营部门经常被访问，但与公共部门相比，案件管理实践相对较差。
Background: Access to artemisinin-based combination therapy (ACT) remains limited in high malaria-burden countries, and there are concerns that the poorest people are particularly disadvantaged. This paper presents new evidence on household treatment-seeking behaviour in six African countries. These data provide a baseline for monitoring interventions to increase ACT coverage, such as the Affordable Medicines Facility for malaria (AMFm).Methods: Nationally representative household surveys were conducted in Benin, the Democratic Republic of Congo (DRC), Madagascar, Nigeria, Uganda and Zambia between 2008 and 2010. Caregivers responded to questions about management of recent fevers in children under five. Treatment indicators were tabulated across countries, and differences in case management provided by the public versus private sector were examined using chi-square tests. Logistic regression was used to test for association between socioeconomic status and 1) malaria blood testing, and 2) ACT treatment.Results: Fever treatment with an ACT is low in Benin (10%), the DRC (5%), Madagascar (3%) and Nigeria (5%), but higher in Uganda (21%) and Zambia (21%). The wealthiest children are significantly more likely to receive ACT compared to the poorest children in Benin (OR = 2.68, 95% CI = 1.12-6.42); the DRC (OR = 2.18, 95% CI = 1.12-4.24); Madagascar (OR = 5.37, 95% CI = 1.58-18.24); and Nigeria (OR = 6.59, 95% CI = 2.73-15.89). Most caregivers seek treatment outside of the home, and private sector outlets are commonly the sole external source of treatment (except in Zambia). However, children treated in the public sector are significantly more likely to receive ACT treatment than those treated in the private sector (except in Madagascar). Nonetheless, levels of testing and ACT treatment in the public sector are low. Few caregivers name the national first-line drug as most effective for treating malaria in Madagascar (2%), the DRC (2%), Nigeria (4%) and Benin (10%). Awareness is higher in Zambia (49%) and Uganda (33%).Conclusions: Levels of effective fever treatment are low and inequitable in many contexts. The private sector is frequently accessed however case management practices are relatively poor in comparison with the public sector.