Eriksen J, Tomson G, Mujinja P, Warsame M Y, Jahn A, Gustafsson L L
Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden.
Trop Med Int Health. 2007 Jan;12(1):52-61. doi: 10.1111/j.1365-3156.2006.01753.x.
To study the quality of malaria case management of underfives at health facilities in a rural district, 2 years after the Tanzanian malaria treatment policy change in 2001.
Consultations of 117 sick underfives by 12 health workers at 8 health facilities in Mkuranga District, Tanzania were observed using checklists for history taking, counselling and prescription. Diagnoses and treatment were recorded. Exit interviews were performed with all mothers/guardians and blood samples taken from the underfives for the detection of malaria parasites and antimalarial drugs. Quality of care was measured using indicators adopted from the integrated management of childhood illnesses multi-country evaluation.
Quality of care measured by indicator scores averaged 31% of what was considered optimal. The poorest results were for history taking. Nevertheless, 89% of febrile children were treated with antimalarials, in line with national guidelines for fever treatment. Of these, 61% had a parasitaemia > or =2000/microl. There was no difference in treatment given to those with parasitological malaria compared with those without parasites. Pre-treatment levels of chloroquine and sulphadoxine/pyrimethamine were low and detected in 2% and 13%, respectively.
Although most febrile children were given antimalarial treatment, quality of care in terms of history taking and counselling was sub-optimal. Despite this, the study community had changed behaviour from self-treatment to seeking care at health facilities. This is encouraging for introduction of artemisinin-based combination therapies policies as one could focus resources into improving care at health facilities and still reach out with treatment to most febrile children.
在2001年坦桑尼亚疟疾治疗政策改变两年后，研究某农村地区卫生机构中五岁以下儿童疟疾病例管理的质量。
使用用于病史采集、咨询和开处方的清单，观察了坦桑尼亚姆库兰加区8家卫生机构的12名卫生工作者对117名患病五岁以下儿童的诊疗过程。记录诊断和治疗情况。对所有母亲/监护人进行了出院访谈，并采集了五岁以下儿童的血样以检测疟原虫和抗疟药物。使用从儿童疾病综合管理多国评估中采用的指标来衡量护理质量。
通过指标得分衡量的护理质量平均为最佳水平的31%。病史采集方面的结果最差。然而，89%的发热儿童接受了抗疟治疗，这符合国家发热治疗指南。其中，61%的儿童疟原虫血症≥2000/微升。患寄生虫性疟疾的儿童与未患寄生虫的儿童在治疗上没有差异。氯喹和周效磺胺/乙胺嘧啶的治疗前水平较低，分别在2%和13%的儿童中检测到。
虽然大多数发热儿童接受了抗疟治疗，但在病史采集和咨询方面的护理质量并不理想。尽管如此，研究社区已从自我治疗转变为到卫生机构寻求护理。这对于引入以青蒿素为基础的联合疗法政策是令人鼓舞的，因为可以将资源集中用于改善卫生机构的护理，同时仍能为大多数发热儿童提供治疗。
