修订后的诊断建议对肯尼亚各年龄组疟疾治疗实践的影响。
Effects of revised diagnostic recommendations on malaria treatment practices across age groups in Kenya.
作者信息
Zurovac D, Njogu J, Akhwale W, Hamer D H, Larson B A, Snow R W
机构信息
Malaria Public Health and Epidemiology Group, KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya.
出版信息
Trop Med Int Health. 2008 Jun;13(6):784-7. doi: 10.1111/j.1365-3156.2008.02072.x.
OBJECTIVE
The recent change of treatment policy for uncomplicated malaria from sulfadoxine-pyrime-thamine to artemether-lumefantrine (AL) in Kenya was accompanied by revised malaria diagnosis recommendations promoting presumptive antimalarial treatment in young children and parasitological diagnosis in patients 5 years and older. We evaluated the impact of these age-specific recommendations on routine malaria treatment practices 4-6 months after AL treatment was implemented.
METHODS
Cross-sectional, cluster sample survey using quality-of-care assessment methods in all government facilities in four Kenyan districts. Analysis was restricted to the 64 facilities with malaria diagnostics and AL available on the survey day. Main outcome measures were antimalarial treatment practices for febrile patients stratified by age, use of malaria diagnostic tests, and test result.
RESULTS
Treatment practices for 706 febrile patients (401 young children and 305 patients > or =5 years) were evaluated. 43.0% of patients > or =5 years and 25.9% of children underwent parasitological malaria testing (87% by microscopy). AL was prescribed for 79.7% of patients > or =5 years with positive test results, for 9.7% with negative results and for 10.9% without a test. 84.6% of children with positive tests, 19.2% with negative tests, and 21.6% without tests were treated with AL. At least one antimalarial drug was prescribed for 75.0% of children and for 61.3% of patients > or =5 years with a negative test result.
CONCLUSIONS
Despite different recommendations for patients below and above 5 years of age, malaria diagnosis and treatment practices were similar in the two age groups. Parasitological diagnosis was under-used in older children and adults, and young children were still tested. Use of AL was low overall and alternative antimalarials were commonly prescribed; but AL prescribing largely followed the results of malaria tests. Malaria diagnosis recommendations differing between age groups appear complex to implement; further strengthening of diagnosis and treatment practices under AL policy is required.
目的
在肯尼亚，针对单纯性疟疾的治疗政策近期从磺胺多辛-乙胺嘧啶改为蒿甲醚-本芴醇（AL），同时修订了疟疾诊断建议，提倡对幼儿进行推定抗疟治疗，对5岁及以上患者进行寄生虫学诊断。我们评估了这些针对特定年龄的建议在实施AL治疗4至6个月后对常规疟疾治疗实践的影响。
方法
采用医疗质量评估方法，在肯尼亚四个地区的所有政府医疗机构中进行横断面整群抽样调查。分析仅限于在调查当天具备疟疾诊断能力且有AL药物的64家医疗机构。主要观察指标为按年龄分层的发热患者的抗疟治疗实践、疟疾诊断检测的使用情况及检测结果。
结果
对706例发热患者（401例幼儿和305例年龄≥5岁的患者）的治疗实践进行了评估。年龄≥5岁的患者中43.0%以及幼儿中25.9%接受了疟疾寄生虫学检测（87%通过显微镜检查）。检测结果呈阳性的年龄≥5岁的患者中79.7%被开具了AL，检测结果呈阴性的患者中9.7%以及未进行检测的患者中10.9%被开具了AL。检测结果呈阳性的幼儿中84.6%、呈阴性的幼儿中19.2%以及未进行检测的幼儿中21.6%接受了AL治疗。检测结果呈阴性的幼儿中75.0%以及年龄≥5岁的患者中61.3%至少被开具了一种抗疟药物。
结论
尽管针对5岁以下和5岁及以上患者有不同的建议，但两个年龄组的疟疾诊断和治疗实践相似。年龄较大的儿童和成人对寄生虫学诊断的利用不足，而幼儿仍接受检测。AL的总体使用率较低，且常用其他抗疟药物；但AL的开具很大程度上遵循了疟疾检测结果。不同年龄组之间不同的疟疾诊断建议实施起来似乎很复杂；需要在AL政策下进一步加强诊断和治疗实践。
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