Hamer Davidson H, Ndhlovu Micky, Zurovac Dejan, Fox Matthew, Yeboah-Antwi Kojo, Chanda Pascalina, Sipilinyambe Naawa, Simon Jonathon L, Snow Robert W
Center for International Health and Development, Boston University School of Public Health, Boston, Mass 02118, USA.
JAMA. 2007 May 23;297(20):2227-31. doi: 10.1001/jama.297.20.2227.
Improving the accuracy of malaria diagnosis with rapid antigen-detection diagnostic tests (RDTs) has been proposed as an approach for reducing overtreatment of malaria in the current era of widespread implementation of artemisinin-based combination therapy in sub-Saharan Africa.
To assess the association between use of microscopy and RDT and the prescription of antimalarials.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, cluster sample survey, carried out between March and May 2006, of all outpatients treated during 1 working day at government and mission health facilities in 4 sentinel districts in Zambia.
Proportions of patients undergoing malaria diagnostic procedures and receiving antimalarial treatment.
Seventeen percent of the 104 health facilities surveyed had functional microscopy, 63% had RDTs available, and 73% had 1 or more diagnostics available. Of patients with fever (suspected malaria), 27.8% (95% confidence interval [CI], 13.1%-42.5%) treated in health facilities with malaria diagnostics were tested and 44.6% had positive test results. Of patients with negative blood smear results, 58.4% (95% CI, 36.7%-80.2%) were prescribed an antimalaria drug, as were 35.5% (95% CI, 16.0%-55.0%) of those with a negative RDT result. Of patients with fever who did not have diagnostic tests done, 65.9% were also prescribed antimalarials. In facilities with artemether-lumefantrine in stock, this antimalarial was prescribed to a large proportion of febrile patients with a positive diagnostic test result (blood smear, 75.0% [95% CI, 51.7%-98.3%]; RDT, 70.4% [95% CI, 39.3%-100.0%]), but also to some of those with a negative diagnostic test result (blood smear, 30.4% [95% CI, 8.0%-52. 9%]; RDT, 26.7% [95% CI, 5.7%-47.7%]).
Despite efforts to expand the provision of malaria diagnostics in Zambia, they continue to be underused and patients with negative test results frequently receive antimalarials. Provision of new tools to reduce inappropriate use of new expensive antimalarial treatments must be accompanied by a major change in clinical treatment of patients presenting with fever but lacking evidence of malaria infection.
在撒哈拉以南非洲广泛实施以青蒿素为基础的联合疗法的当前时代，提高快速抗原检测诊断试验（RDT）对疟疾诊断的准确性已被提议作为减少疟疾过度治疗的一种方法。
评估显微镜检查和RDT的使用与抗疟药处方之间的关联。
设计、地点和参与者：2006年3月至5月期间，在赞比亚4个哨点地区的政府和教会卫生设施对1个工作日内治疗的所有门诊患者进行了横断面整群抽样调查。
接受疟疾诊断程序和接受抗疟治疗的患者比例。
在接受调查的104家卫生设施中，17%具备功能正常的显微镜，63%有RDT可用，73%有1种或更多诊断方法可用。在发热（疑似疟疾）患者中，在有疟疾诊断方法的卫生设施接受治疗的患者中，27.8%（95%置信区间[CI]，13.1%-42.5%）接受了检测，44.6%检测结果呈阳性。血涂片结果为阴性的患者中，58.4%（95%CI，36.7%-80.2%）被开具了抗疟药，RDT结果为阴性的患者中这一比例为35.5%（95%CI，16.0%-55.0%）。未进行诊断检测的发热患者中，65.9%也被开具了抗疟药。在有蒿甲醚-本芴醇库存的设施中，很大一部分诊断检测结果呈阳性的发热患者（血涂片，75.0%[95%CI，51.7%-98.3%]；RDT，70.4%[95%CI，39.3%-100.0%]）被开具了这种抗疟药，但一些诊断检测结果为阴性的患者（血涂片，30.4%[95%CI，8.0%-52.9%]；RDT，26.7%[95%CI，5.7%-47.7%]）也被开具了。
尽管赞比亚努力扩大疟疾诊断方法的提供，但这些方法仍未得到充分利用，检测结果为阴性的患者经常接受抗疟药治疗。在提供减少不适当使用新型昂贵抗疟治疗方法的新工具时，必须同时对发热但缺乏疟疾感染证据的患者的临床治疗进行重大改变。
