Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study
Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study
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DOI：
10.1093/cid/ciw622
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发表时间：
2016-12-15
影响因子：
11.8
通讯作者：
Gomes, Melba
中科院分区：
文献类型：
--
作者：
Ajayi, IkeOluwapo O.;Nsungwa-Sabiiti, Jesca;Gomes, Melba
背景鼓励疟疾流行国家增加、加快和规范基于寄生虫诊断的护理，并在患者无法口服药物时，使用口服青蒿素联合疗法（ACT）或直肠青蒿琥酯加转诊治疗确诊的疟疾。在3个非洲国家的172个村庄，经过培训的社区卫生工作者使用基于快速富组氨酸蛋白2（HRP 2）的诊断测试（RDTs）评估和诊断6个月至6岁的儿童。前来接受治疗的患者可以服用口服药物，接受以青蒿素为基础的综合疗法治疗，不能接受口服药物的患者接受直肠青蒿琥酯治疗并转诊至医院。完整的综合干预方案持续了12个月。通过干预前的1746个随机家庭访谈和干预期间的3199个随机家庭访谈，确定了获得护理和临床过程的速度和变化。共有15932名儿童接受了评估：布基纳法索6394名，尼日利亚2148名，乌干达7390名。大多数评估的儿童（97.3% [15 495/15 932]）发热，大多数发热病例（82.1% [12 725/15 495]）检测为RDT阳性。几乎一半的无发热发作（47.6% [204/429]）为RDT阳性。符合直肠青蒿琥酯的儿童占发作的1.1%。使用CHW作为第一个护理点的几率增加了一倍（比值比[OR]，2.15; 95%置信区间[CI]，1.9-2.4; P
Background. Malaria-endemic countries are encouraged to increase, expedite, and standardize care based on parasite diagnosis and treat confirmed malaria using oral artemisinin-based combination therapy (ACT) or rectal artesunate plus referral when patients are unable to take oral medication.Methods. In 172 villages in 3 African countries, trained community health workers (CHWs) assessed and diagnosed children aged between 6 months and 6 years using rapid histidine-rich protein 2 (HRP2)-based diagnostic tests (RDTs). Patients coming for care who could take oral medication were treated with ACTs, and those who could not were treated with rectal artesunate and referred to hospital. The full combined intervention package lasted 12 months. Changes in access and speed of care and clinical course were determined through 1746 random household interviews before and 3199 during the intervention.Results. A total of 15 932 children were assessed: 6394 in Burkina Faso, 2148 in Nigeria, and 7390 in Uganda. Most children assessed (97.3% [15 495/15 932]) were febrile and most febrile cases (82.1% [12 725/15 495]) tested were RDT positive. Almost half of afebrile episodes (47.6% [204/429]) were RDT positive. Children eligible for rectal artesunate contributed 1.1% of episodes. The odds of using CHWs as the first point of care doubled (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.9-2.4; P