Eriksen Jaran, Nsimba Stephen E D, Minzi Omary M S, Sanga Anku J, Petzold Max, Gustafsson Lars L, Warsame Marian Y, Tomson Göran
Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden.
Trop Med Int Health. 2005 Oct;10(10):1038-46. doi: 10.1111/j.1365-3156.2005.01486.x.
To assess the diffusion of the change of first line antimalarial drug from chloroquine (CQ) to sulphadoxine/pyrimethamine (SP) at household level in a rural district of Tanzania less than a year after the policy implementation.
Caretakers in 729 households were interviewed on knowledge of the new policy, home stocking of antimalarials, home-treatment practices of children younger than 5 years with fever, health-seeking behaviour and experience of SP. SP and CQ levels in blood were analysed from 328 children younger than 5 years in the households. Twelve focus group discussions (FGD) were performed with mothers, fathers and health workers.
About 51% of the population knew that SP was the first line antimalarial. Only 8% of mothers stocked antimalarials, and only 4% stated self-treatment as the first action. We estimated that 84% of the children who had had fever during the last 4 weeks sought care at public health facilities. SP was detectable in 18% of the total child population and in 32% of those with reported fever, CQ in only 5% and 7%, respectively. The FGDs revealed negative perceptions of SP and fear of severe adverse reactions with mass media reported as key informant.
The policy had diffused to the communities in the sense that CQ had been changed to SP, which was well known as first line treatment. Moreover, there was a reported dramatic change from self-treatment with CQ to seeking care at public health facilities where SP was given under observation.
在坦桑尼亚农村地区一项政策实施不到一年后，评估家庭层面一线抗疟药物从氯喹（CQ）向磺胺多辛/乙胺嘧啶（SP）转变的普及情况。
对729户家庭的照料者进行访谈，内容包括对新政策的了解、家庭抗疟药物储备、5岁以下发热儿童的家庭治疗做法、就医行为以及对SP的使用体验。对这些家庭中328名5岁以下儿童的血液中的SP和CQ水平进行了分析。与母亲、父亲和卫生工作者进行了12次焦点小组讨论（FGD）。
约51%的人口知道SP是一线抗疟药物。只有8%的母亲储备了抗疟药物，只有4%的人表示自我治疗是首要行动。我们估计，在过去4周内发热的儿童中，84%在公共卫生机构寻求治疗。在全部儿童人口中，18%可检测到SP，在报告有发热的儿童中，这一比例为32%；CQ的检测比例分别仅为5%和7%。焦点小组讨论显示，人们对SP有负面看法，并且担心会出现严重不良反应，大众媒体被报告为主要信息来源。
从CQ已被更换为广为人知的一线治疗药物SP这一点来看，该政策已在社区中得到普及。此外，据报告，从用CQ进行自我治疗到在公共卫生机构接受观察下给予SP治疗的就医行为发生了显著变化。
