Adherence to prescribed artemisinin-based combination therapy in Garissa and Bunyala districts, Kenya.
Adherence to prescribed artemisinin-based combination therapy in Garissa and Bunyala districts, Kenya.
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肯尼亚加里萨和布尼亚拉地区坚持以青蒿素为基础的联合疗法。
DOI：
10.1186/1475-2875-10-281
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发表时间：
2011-09-23
期刊：
影响因子：
3
通讯作者：
Allan R
中科院分区：
文献类型：
--
作者：
Lawford H;Zurovac D;O'Reilly L;Hoibak S;Cowley A;Munga S;Vulule J;Juma E;Snow RW;Allan R
在对抗疟疾单一疗法产生抗药性之后，非洲疟疾流行国家现在使用青蒿素综合疗法作为推荐的无并发症疟疾一线治疗。患者坚持使用青蒿素综合疗法是确保治疗效果以及减少寄生虫对这些药物产生抗药性的可能性的一个重要因素。本研究报告了在肯尼亚常规临床实践条件下对特定ACT蒿甲醚-苯芴醇（AL）的依从性。这项研究是在加里萨和本亚拉地区的五个政府保健设施的门诊病人中进行的。接受AL治疗的患者在开药后四天在家中接受访问。使用标准化问卷对应答者（≥ 15岁的患者和< 15岁的患者护理者）进行访谈，对AL泡罩包装进行物理检查，然后记录患者的依从性状态。多变量逻辑回归模型用于确定依从性的预测因素。在纳入研究的918例患者中，588例（64.1%）为“很可能依从”，291例（31.7%）为“明确非依从”，39例（4.2%）为“很可能非依从”。发现六个因素是依从性的重要预测因素：患者对ACT给药方案的了解（比值比（OR）= 1.76; 95% CI = 1.32-2.35），患者年龄（OR = 1.65; 95%CI = 1.02-1.85），受访者年龄（OR = 1.37; 95%CI = 1.10-2.48），受访者以前是否见过AL（OR = 1.46; 95%CI = 1.08-1.98），患者是否报告不喜欢AL（OR = 0.62，95%CI = 0.47-0.82）和是否等待治疗超过24小时（OR = 0.73，95%CI = 0.54-0.99）。总体而言，在加里萨和本亚拉地区，AL的依从性较低，患者对AL给药方案的了解是依从性最强的预测因素。旨在提高社区对AL给药方案的认识、使用儿童友好型制剂和改善卫生工作者处方实践的干预措施可能会确保更高的AL依从性和最终的治疗成功。
Following the development of resistance to anti-malarial mono-therapies, malaria endemic countries in Africa now use artemisinin-based combination therapy (ACT) as recommended first-line treatment for uncomplicated malaria. Patients' adherence to ACT is an important factor to ensure treatment efficacy, as well as to reduce the likelihood of parasite resistance to these drugs. This study reports adherence to a specific ACT, artemether-lumefantrine (AL), under conditions of routine clinical practice in Kenya. The study was undertaken in Garissa and Bunyala districts among outpatients of five government health facilities. Patients treated with AL were visited at home four days after having been prescribed the drug. Respondents (patients ≥ 15 years and caregivers of patients < 15 years) were interviewed using a standardized questionnaire, AL blister packs were physically inspected and the adherence status of patients was then recorded. Multivariate logistic regression modelling was used to determine predictors of adherence. Of the 918 patients included in the study, 588 (64.1%) were 'probably adherent', 291 (31.7%) were 'definitely non-adherent' and 39 (4.2%) were 'probably non-adherent'. Six factors were found to be significant predictors of adherence: patient knowledge of the ACT dosing regimen (odds ratio (OR) = 1.76; 95% CI = 1.32-2.35), patient age (OR = 1.65; 95% CI = 1.02-1.85), respondent age (OR = 1.37; 95% CI = 1.10-2.48), whether a respondent had seen AL before (OR = 1.46; 95% CI = 1.08-1.98), whether a patient had reported dislikes to AL (OR = 0.62 95% CI = 0.47-0.82) and whether a respondent had waited more than 24 hours to seek treatment (OR = 0.73; 95% CI = 0.54-0.99). Overall, adherence to AL was found to be low in both Garissa and Bunyala districts, with patient knowledge of the AL dosing regimen found to be the strongest predictor of adherence. Interventions aimed at increasing community awareness of the AL dosing regimen, use of child friendly formulations and improving health workers' prescribing practices are likely to ensure higher adherence to AL and eventual treatment success.
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影响因子：
3.7
作者：
Noor AM;Gething PW;Alegana VA;Patil AP;Hay SI;Muchiri E;Juma E;Snow RW
通讯作者：
Snow RW
影响因子：
3
作者：
Dzeing-Ella, A;Obiang, PCN;Kombila, M
通讯作者：
Kombila, M
影响因子：
3.3
作者：
Depoortere, E;Guthmann, JP;Legros, D
通讯作者：
Legros, D
DOI：
10.1016/s0035-9203(01)90252-4
发表时间：
2001-05-01
影响因子：
2.2
作者：
Okonkwo, PO;Akpala, CO;Nwaiwu, O
通讯作者：
Nwaiwu, O
DOI：
10.4269/ajtmh.2009.80.737
发表时间：
2009-05-01
影响因子：
3.3
作者：
Kangwana, Beth B.;Njogu, Julius;Snow, Robert W.
通讯作者：
Snow, Robert W.