Mehta U, Durrheim D N, Blumberg L, Donohue S, Hansford F, Mabuza A, Kruger P, Gumede J K, Immelman E, Sánchez Canal A, Hugo J J, Swart G, Barnes K I
Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa.
Trop Med Int Health. 2007 May;12(5):617-28. doi: 10.1111/j.1365-3156.2007.01823.x.
To identify case management, health system and antimalarial drug factors contributing to malaria deaths.
We investigated malaria-related deaths in South Africa's three malaria endemic provinces from January 2002 to July 2004. Data from healthcare facility records and a semi-structured interview with patients' contacts were reviewed by an expert panel, which sought to reach consensus on factors contributing to the death. This included possible health system failures, adverse reactions to antimalarials, inappropriate medicine use and failing to respond to treatment.
Approximately 177 of 197 cases met inclusion criteria for the study. Delay in seeking formal health care was significantly longer for patients who sought traditional health care [median 4; inter-quartile range (IQR) 3-7 days] than for patients who did not (median 3; IQR 1-5 days; P = 0.033). Patients with confirmed or suspected HIV/AIDS were significantly more likely to use traditional approaches (25%) than those with other comorbidities (0%; P = 0.002). Malaria was neither suspected nor tested for at a primary care facility in 23% of cases with adequate records. Initial hospital assessment was considered inadequate in 74% of cases admitted to hospital and in-patient monitoring and management was adequate in only 27%. There were 32 suspected adverse reactions to antimalarial therapy.
A confidential enquiry into malaria-related deaths is a useful tool for identifying preventable factors, health system failures and adverse events affecting malaria case management.
确定导致疟疾死亡的病例管理、卫生系统和抗疟药物因素。
我们调查了2002年1月至2004年7月期间南非三个疟疾流行省份与疟疾相关的死亡情况。专家小组审查了医疗机构记录数据以及对患者联系人进行的半结构化访谈数据，旨在就导致死亡的因素达成共识。这包括可能的卫生系统故障、对抗疟药物的不良反应、用药不当以及治疗无反应。
197例病例中约177例符合该研究的纳入标准。寻求传统医疗服务的患者寻求正规医疗服务的延迟时间显著更长[中位数为4天；四分位间距（IQR）为3 - 7天]，而未寻求传统医疗服务的患者延迟时间为中位数3天（IQR为1 - 5天；P = 0.033）。确诊或疑似感染艾滋病毒/艾滋病的患者比患有其他合并症的患者更有可能采用传统方法（25% 对0%；P = 0.002）。在有充分记录的病例中，23%在基层医疗机构未被怀疑或检测出疟疾。在入院的病例中，74%的病例初始医院评估被认为不充分，住院监测和管理充分的仅占27%。有32例疑似对抗疟治疗的不良反应。
对与疟疾相关的死亡进行保密调查是识别可预防因素、卫生系统故障以及影响疟疾病例管理的不良事件的有用工具。
