Okonkwo P O, Akpala C O, Okafor H U, Mbah A U, Nwaiwu O
Department of Pharmacology and Therapeutics, University of Nigeria Teaching Hospital, PMB 01129, Enugu, Nigeria.
Trans R Soc Trop Med Hyg. 2001 May-Jun;95(3):320-4. doi: 10.1016/s0035-9203(01)90252-4.
Non-compliance to correct dosing is thought to be one of the main causes of treatment failure of chloroquine in the home management of childhood malaria. There are few studies of compliance to drugs used for tropical diseases. In order to study compliance in the rural setting, chloroquine syrup was packaged with a novel pictorial insert for compliance to correct dosing. Compliance was assessed in a field trial in September 1996-December 1997, involving 632 children with uncomplicated malaria in Udi local government area in Nigeria. Written informed consent was obtained from mothers/guardians before children were enrolled in the study. There were 3 arms to the trial: control villages (group I) received chloroquine syrup without further intervention, group II received a pictorial insert with chloroquine syrup, and group III received chloroquine syrup, the pictorial insert and verbal instructions. Each group was made up of 3 health centres. Compliance was assessed by volumetric measurement of the chloroquine syrup left in 30-mL bottles and by questionnaires administered to mothers/helpers of the children. Control villages recorded full compliance for 36.5 +/- 4.4% of the children, group II for 51.9 +/- 7.9% and group III for 73.3 +/- 4.2%. There was a significant correlation (P < 0.0001) between full compliance, improvement and time for improvement of the condition. This study is deemed important because it focuses on children, who bear the greatest burden of malaria. It is unique for introducing a pictorial insert that illiterate villagers, who may not understand the use of age or weight in drug dispensing, may utilize as a substitute.
不遵守正确剂量被认为是儿童疟疾家庭治疗中氯喹治疗失败的主要原因之一。关于热带疾病用药依从性的研究很少。为了研究农村地区的依从性，氯喹糖浆被包装上了一种新颖的用于正确给药依从性的图片插页。1996年9月至1997年12月在尼日利亚乌迪地方政府地区进行了一项现场试验，对632名患单纯性疟疾的儿童的依从性进行了评估。在儿童纳入研究之前，已获得母亲/监护人的书面知情同意。该试验有3组：对照组村庄（第一组）接受氯喹糖浆，无进一步干预；第二组接受氯喹糖浆及图片插页；第三组接受氯喹糖浆、图片插页和口头指导。每组由3个卫生中心组成。通过对30毫升瓶中剩余氯喹糖浆的容量测量以及向儿童的母亲/帮助者发放问卷来评估依从性。对照组村庄记录的儿童完全依从率为36.5±4.4%，第二组为51.9±7.9%，第三组为73.3±4.2%。完全依从、病情改善和病情改善时间之间存在显著相关性（P<0.0001）。这项研究被认为很重要，因为它关注的是疟疾负担最重的儿童。它的独特之处在于引入了一种图片插页，不识字的村民可能不理解在配药时使用年龄或体重的方法，但可以将其用作替代方法。
