Ratsimbasoa Arsène, Randrianarivelojosia Milijaona, Millet Pascal, Soarès Jean Louis, Rabarijaona Leon, Rakotoson Benjamin, Malvy Denis, Ménard Didier
Malaria Unit Research, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar.
Malar J. 2006 Sep 14;5:79. doi: 10.1186/1475-2875-5-79.
The main objective of this study was to assess the quality of home malaria management with pre-packaged chloroquine in two areas in the Moramanga district of Madagascar. The knowledge, attitude and practices of care providers in terms of home treatment options were evaluated and compared. The availability of treatment options by studying retailers and community-based service providers was also investigated.
A cross-sectional investigation in two communities, in the hamlets and villages located close to carers, retailers, community-based service providers and primary health centres was carried out.
Carers in the two districts were equally well aware of the use of pre-packaged chloroquine. Their first response to the onset of fever was to treat children with this antimalarial drug at home. The dose administered and treatment compliance were entirely satisfactory (100%) with pre-packaged chloroquine and rarely satisfactory (1.6% to 4.5%) with non pre-packaged chloroquine. In cases of treatment failure, the carers took patients to health centres. Chloroquine was supplied principally by private pharmacies and travelling salesmen selling unpackaged chloroquine tablets. Non pre-packaged chloroquine was the most common drug used at health centres. The frequency of positive rapid malaria tests (P = 0.01) was significantly higher in children treated with non pre-packaged chloroquine (38%) than in children treated with pre-packaged chloroquine (1.3%).
Home malaria management should be improved in Madagascar. Efforts should focus on communication, the training of community-based service providers, access to pre-packaged drugs and the gradual withdrawal of pre-packaged chloroquine and its replacement by pre-packaged artemisinin-based combination therapies.
本研究的主要目的是评估在马达加斯加穆龙达瓦区的两个地区使用预包装氯喹进行家庭疟疾管理的质量。对护理人员在家庭治疗选择方面的知识、态度和做法进行了评估和比较。还通过研究零售商和社区服务提供者来调查治疗选择的可及性。
在两个社区进行了横断面调查，这些社区位于靠近护理人员、零售商、社区服务提供者和初级卫生中心的小村庄和村庄。
两个地区的护理人员对预包装氯喹的使用了解程度相同。他们对发烧发作的第一反应是在家中用这种抗疟药物治疗儿童。预包装氯喹的给药剂量和治疗依从性完全令人满意（100%），而非预包装氯喹的给药剂量和治疗依从性则很少令人满意（1.6%至4.5%）。在治疗失败的情况下，护理人员会带患者去卫生中心。氯喹主要由私人药店和销售未包装氯喹片剂的流动推销员供应。非预包装氯喹是卫生中心最常用的药物。使用非预包装氯喹治疗的儿童（38%）中快速疟疾检测呈阳性的频率（P = 0.01）显著高于使用预包装氯喹治疗的儿童（1.3%）。
马达加斯加应改善家庭疟疾管理。应努力加强沟通，培训社区服务提供者，提供预包装药物，并逐步停用预包装氯喹，代之以预包装青蒿素联合疗法。
