Tarimo D S, Malekela D A
Department of Parasitology & Medical Entomology, School of Public Health & Social Sciences, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
East Afr J Public Health. 2007 Apr;4(1):43-6.
To describe, from health workers (HWs) perspectives, the potential and actual barriers to the implementation of the first change of policy from chloroquine (CQ) to Sulfadoxine / Sulfalane - Pyrimewthamine (SP) in preparation for the second change of policy to Artemisinin based Combination Therapies (ACTs).
A descriptive cross-sectional survey of HWs using questionnaire interviews was carried out in public and private health facilities in Songea Urban district. The interview concerned awareness and knowledge on the commonly used antimalarial drugs as given in the new policy, focusing on SP use and the associated side effects as well as perceptions on the potency and safety of SP versus CQ and the perceived alternative antimalarial drugs to non-response or reaction to SP.
Awareness on the new policy was very high; 91.4% of HWs were aware that SP was the new drug. Although the majority of HWs (81.9%) reported using the new policy as soon as it was out, a significant percentage (76.2%) reported continued use of SP (P-value < 0.001). SP was perceived to have a low potency in that it was slow in fever clearance. A significant percentage (65.7%) of HWs reported a history of problems with SP use namely headaches and skin reactions. Quinine (QN) was significantly frequently mentioned as the perceived alternative drug to CQ (61.1%) and non-response (56.6%) or reaction (54.1%) to SP.
Findings show that SP was generally not preferred by HWs, and they continued to use CQ despite the evidence that it was no longer effective indicating that. HWs tend to maintain perceptions based on their experiences with drugs currently in use. Pertinent information, education and behaviour change communication strategies related to the change from SP to ACT should focus on the fact that the previous drug is no longer effective so as to induce consistent use of the new drug.
从卫生工作者的角度描述在为第二次政策转变为以青蒿素为基础的联合疗法（ACTs）做准备时，从氯喹（CQ）到磺胺多辛/乙胺嘧啶（SP）的首次政策转变实施过程中的潜在障碍和实际障碍。
在松盖阿市区的公立和私立卫生机构中，对卫生工作者进行了一项使用问卷调查的描述性横断面调查。访谈内容涉及对新政策中常用抗疟药物的认识和了解，重点是SP的使用及其相关副作用，以及对SP与CQ效力和安全性的看法，以及对SP无反应或有反应时可替代的抗疟药物的看法。
对新政策的知晓率非常高；91.4%的卫生工作者知道SP是新药。尽管大多数卫生工作者（81.9%）报告在新政策出台后立即采用，但仍有相当比例（76.2%）报告继续使用SP（P值<0.001）。人们认为SP效力较低，因为它退热缓慢。相当比例（65.7%）的卫生工作者报告有使用SP的问题史，即头痛和皮肤反应。奎宁（QN）被显著频繁地提及为CQ的替代药物（61.1%），以及对SP无反应（56.6%）或有反应（54.1%）时的替代药物。
研究结果表明，卫生工作者一般不喜欢SP，尽管有证据表明CQ不再有效，但他们仍继续使用CQ，这表明卫生工作者倾向于根据他们对当前使用药物的经验来维持看法。与从SP转变为ACT相关的相关信息、教育和行为改变沟通策略应侧重于前一种药物不再有效的事实，以便促使人们持续使用新药。
