Ndiaye P, Tal-Dia A, Diedhiou A, Juergens-Behr A, Lemort J P
Service de médecine préventive et santé publique, UCAD-DAKAR, BP 16 390, Dakar-Fann, Sénégal.
Med Trop (Mars). 2006 Feb;66(1):74-8.
Malaria is assimilated with its cardinal symptom, i.e., fever. Treatment of fever with antimalarial drugs is crucial to the prevention of malaria-related death in Senegal. The objective of this study was to analyze fever-treatment practices as a basis for making realistic recommendations for self-treatment in the northern health district of Dakar, Senegal. This cross-sectional study was conducted from March 1 to April 30, 2003. The population included all patients with body temperature higher or equal to 37.5 degrees C (99.5 degrees F) associated with at least one of the following symptoms: headache, shivering, vomiting and diarrhoea. Study endpoints included demographic data and fever treatment modalities including the nature, dosage, and duration of the drugs used. Malaria was suspected in 180 of the 271 patients enrolled in the study. Treatment had already been undertaken in 134 patients including 108 (81%) who had initiated self-treatment. Drugs included antipyretics, antibiotics, and/or antimalarials. Antimalarial drug dosage was incorrect in 84% of those who initiated self-treatment. Dosage errors involved number of daily doses (55%), duration of treatment (13%), or both (32%). Only 45% of patients fully completed treatment. Medical advice was sought in 30% of the cases and drugs were obtained over the counter in pharmacies in 59%. Patients under the age of 15 years were significantly more likely to initiate self-treatment (p=6.10-6), to treat symptoms early, and to use an antimalarial (p=4.10-6). Although self-treatment shortened the delay between onset of symptoms and initiation of treatment, it is likely that indiscriminate and incomplete treatment is responsible for development of resistance to chloroquine in the northern health district of Dakar. Strategies must be adapted to numerous local factors influencing self-treatment including the availability of health-care services and drugs of quality. Special attention must be given to the improvement of antimalarial drug packaging and of the awareness of people that provide self-treatment drugs.
疟疾与其主要症状即发热联系在一起。在塞内加尔，使用抗疟药物治疗发热对于预防疟疾相关死亡至关重要。本研究的目的是分析发热治疗实践，以便为塞内加尔达喀尔北部卫生区的自我治疗提出切实可行的建议。这项横断面研究于2003年3月1日至4月30日进行。研究人群包括所有体温高于或等于37.5摄氏度（99.5华氏度）且伴有以下至少一种症状的患者：头痛、寒战、呕吐和腹泻。研究终点包括人口统计学数据以及发热治疗方式，包括所用药物的种类、剂量和疗程。在纳入研究的271名患者中，有180人疑似感染疟疾。134名患者已经接受了治疗，其中108人（81%）已开始自我治疗。所用药物包括退烧药、抗生素和/或抗疟药。在开始自我治疗的患者中，84%的抗疟药剂量不正确。剂量错误涉及每日剂量次数（55%）、治疗疗程（13%）或两者皆有（32%）。只有45%的患者完成了全部治疗。30%的病例寻求了医疗建议，59%的患者在药店购买了非处方药。15岁以下的患者更有可能开始自我治疗（p = 6.10 - 6）、更早治疗症状并使用抗疟药（p = 4.10 - 6）。虽然自我治疗缩短了症状出现与开始治疗之间的延迟，但在达喀尔北部卫生区，不加区分和不完整的治疗很可能是导致对氯喹产生耐药性的原因。必须根据影响自我治疗的众多当地因素调整策略，包括医疗服务的可及性和优质药物的供应情况。必须特别关注改进抗疟药的包装以及提高提供自我治疗药物人员的意识。
