Malaria rapid testing by community health workers is effective and safe for targeting malaria treatment: randomised cross-over trial in Tanzania.
Malaria rapid testing by community health workers is effective and safe for targeting malaria treatment: randomised cross-over trial in Tanzania.
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DOI：
10.1371/journal.pone.0019753
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Björkman A
中科院分区：
文献类型：
--
作者：
Mubi M;Janson A;Warsame M;Mårtensson A;Källander K;Petzold MG;Ngasala B;Maganga G;Gustafsson LL;Massele A;Tomson G;Premji Z;Björkman A
对无并发症的疟疾进行早期诊断和及时有效的治疗，对于防止严重疾病、死亡和疟疾传播至关重要。我们评估了社区卫生工作者(CHW)的疟疾快速诊断试验(RDT)对发烧患者提供基于青蒿素的联合疗法(ACT)和健康结局的影响。来自坦桑尼亚海岸地区疟疾高传播区Kibaha区五个村庄的22名CHW接受了培训，以仅使用RDT辅助诊断或临床诊断(CD)来管理简单的疟疾。每个CHW被随机分配到第一周使用RDT或CD，此后每周交替使用。主要结果是提供ACT，次要结果是转诊率和第3天和第7天的健康状况。CHWS在5个月内登记了2930名发热患者，其中1988人(67.8%)在发热开始后24小时内出现。在RDT周和CD周分别有775例(53.2%)和1422例(96.5%)患者获得了ACT，优势比(OR)为0.039，95%可信区间为0.029~0.053。1457例患者中有1411例(96.8%，95%可信区间95.8~97.6)符合RDT结果。在RDT周的纳入日转介的患者(10.0%)多于CD周的患者(1.6%)。在RDT辅助诊断后，在第1-7天转诊以及在第3天和第7天感觉没有恢复的情况也更常见。然而，在没有接受ACT治疗的682名RDT组患者中，没有发生致命或严重的疟疾，这支持了对RDT阴性患者保留ACT的安全性。社区卫生工作者手中的RDT可以安全地改善非洲社区一级疟疾患者的早期和有针对性的ACT治疗。临床试验.gov NCT00301015
Early diagnosis and prompt, effective treatment of uncomplicated malaria is critical to prevent severe disease, death and malaria transmission. We assessed the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients. Twenty-two CHWs from five villages in Kibaha District, a high-malaria transmission area in Coast Region, Tanzania, were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis (CD) only. Each CHW was randomly assigned to use either RDT or CD the first week and thereafter alternating weekly. Primary outcome was provision of ACT and main secondary outcomes were referral rates and health status by days 3 and 7. The CHWs enrolled 2930 fever patients during five months of whom 1988 (67.8%) presented within 24 hours of fever onset. ACT was provided to 775 of 1457 (53.2%) patients during RDT weeks and to 1422 of 1473 (96.5%) patients during CD weeks (Odds Ratio (OR) 0.039, 95% CI 0.029–0.053). The CHWs adhered to the RDT results in 1411 of 1457 (96.8%, 95% CI 95.8–97.6) patients. More patients were referred on inclusion day during RDT weeks (10.0%) compared to CD weeks (1.6%). Referral during days 1–7 and perceived non-recovery on days 3 and 7 were also more common after RDT aided diagnosis. However, no fatal or severe malaria occurred among 682 patients in the RDT group who were not treated with ACT, supporting the safety of withholding ACT to RDT negative patients. RDTs in the hands of CHWs may safely improve early and well-targeted ACT treatment in malaria patients at community level in Africa. ClinicalTrials.gov NCT00301015
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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
影响因子：
3
作者：
Kyabayinze DJ;Tibenderana JK;Odong GW;Rwakimari JB;Counihan H
通讯作者：
Counihan H
影响因子：
3
作者：
Ajayi IO;Falade CO;Bamgboye EA;Oduola AM;Kale OO
通讯作者：
Kale OO
DOI：
10.1046/j.1365-2257.1999.00220.x
发表时间：
1999-01-01
期刊：
CLINICAL AND LABORATORY HAEMATOLOGY
影响因子：
--
作者：
Hänscheid, T
通讯作者：
Hänscheid, T
影响因子：
6.4
作者：
Hopkins, Heidi;Bebell, Lisa;Dorsey, Grant
通讯作者：
Dorsey, Grant