基于青蒿素的联合疗法用于非洲四个地区疟疾家庭管理的可行性与可接受性
Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites.
作者信息
Ajayi Ikeoluwapo O, Browne Edmund N, Garshong Bertha, Bateganya Fred, Yusuf Bidemi, Agyei-Baffour Peter, Doamekpor Leticia, Balyeku Andrew, Munguti Kaendi, Cousens Simon, Pagnoni Franco
机构信息
Malaria Research Laboratories, Institute of Medical Research and Training, College of Medicine, University of Ibadan, Nigeria.
出版信息
Malar J. 2008 Jan 8;7:6. doi: 10.1186/1475-2875-7-6.
BACKGROUND
The Home Management of Malaria (HMM) strategy was developed using chloroquine, a now obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT) in health facility settings. Incorporation of ACT in HMM would greatly expand access to effective antimalarial therapy by the populations living in underserved areas in malaria endemic countries. The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated.
METHODS
A multi-country study was performed in four district-size sites in Ghana (two sites), Nigeria and Uganda, with populations ranging between 38,000 and 60,000. Community medicine distributors (CMDs) were trained in each village to dispense pre-packaged ACT to febrile children aged 6-59 months, after exclusion of danger signs. A community mobilization campaign accompanied the programme. Artesunate-amodiaquine (AA) was used in Ghana and artemether-lumefantrine (AL) in Nigeria and Uganda. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance, caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs.
RESULTS
Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites. Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks, of whom 1,289 (59%) were reported to have received ACT from a CMD. Coverage varied from 52% in Nigeria to 75% in Ho District, Ghana. Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver. A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites (range 86-97%, average 90%). The proportion of children correctly treated in terms of dose and duration was also high (range 74-97%, average 85%). Overall, the proportion of febrile children who received prompt treatment and the correct dose for the assigned duration of treatment ranged from 71% to 87% (average 77%). Almost all caregivers perceived ACT to be effective, and no severe adverse events were reported.
CONCLUSION
ACTs can be successfully integrated into the HMM strategy.
背景
家庭疟疾管理（HMM）策略是使用氯喹制定的，氯喹如今已过时，在医疗机构中已被以青蒿素为基础的联合疗法（ACT）所取代。将ACT纳入HMM将极大地扩大疟疾流行国家生活在服务不足地区的人群获得有效抗疟治疗的机会。需要评估将ACT纳入HMM的可行性和可接受性。
方法
在加纳的四个地区规模的地点（两个地点）、尼日利亚和乌干达进行了一项多国研究，人口在38000至60000之间。在每个村庄对社区医学分销商（CMD）进行培训，以便在排除危险体征后，为6至59个月大的发热儿童分发预包装的ACT。该项目伴随了一场社区动员运动。在加纳使用青蒿琥酯-阿莫地喹（AA），在尼日利亚和乌干达使用蒿甲醚-本芴醇（AL）。采用统一的定性和定量数据收集方法来评估CMD的表现、照顾者的依从性以及从CMD处获得的ACT对发热儿童的治疗覆盖率。
结果
在四个研究地点，CMD共使用ACT治疗了约20000例幼儿发热病例。横断面调查确定在前两周有2190名儿童发热，其中1289名（59%）报告从CMD处接受了ACT。覆盖率从尼日利亚的52%到加纳霍区的75%不等。覆盖率似乎不因儿童年龄或照顾者的教育水平而有很大差异。在所有四个地点，报告称很高比例的儿童在发病当天或第二天接受了第一剂治疗（范围为86 - 97%，平均90%）。在剂量和疗程方面正确治疗的儿童比例也很高（范围为74 - 97%，平均85%）。总体而言，接受及时治疗且在规定疗程内接受正确剂量治疗的发热儿童比例在71%至87%之间（平均77%）。几乎所有照顾者都认为ACT有效，且未报告严重不良事件。
结论
ACT可以成功地纳入HMM策略。
Zotero 插件