Disease Control & Vector Biology Unit, Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Malar J. 2010 Nov 22;9:333. doi: 10.1186/1475-2875-9-333.
Currently less than 15% of children under five with fever receive recommended artemisinin-combination therapy (ACT), far short of the Roll Back Malaria target of 80%. To understand why coverage remains low, it is necessary to examine the treatment pathway from a child getting fever to receiving appropriate treatment and to identify critical blockages. This paper presents the application of such a diagnostic approach to the coverage of prompt and effective treatment of children with fever in rural Senegal.
A two-stage cluster sample household survey was conducted in August 2008 in Tambacounda, Senegal, to investigate treatment behaviour for children under five with fever in the previous two weeks. The treatment pathway was divided in to five key steps; the proportion of all febrile children reaching each step was calculated. Results were stratified by sector of provider (public, community, and retail). Logistic regression was used to determine predictors of treatment seeking.
Overall 61.6% (188) of caretakers sought any advice or treatment and 40.3% (123) sought any treatment promptly within 48 hours. Over 70% of children taken to any provider with fever did not receive an anti-malarial. The proportion of febrile children receiving ACT within 48 hours was 6.2% (19) from any source; inclusion of correct dose and duration reduced this to 1.3%. The proportion of febrile children receiving ACT within 48 hours (not including dose & duration) was 3.0% (9) from a public provider, 3.0% (9) from a community source and 0.3% (1) from the retail sector. Inclusion of confirmed diagnosis within the public sector treatment pathway as per national policy increases the proportion of children receiving appropriate treatment with ACT in this sector from 9.4% (9/96) to an estimated 20.0% (9/45).
Process analysis of the treatment pathway for febrile children must be stratified by sector of treatment-seeking. In Tambacounda, Senegal, interventions are needed to increase prompt care-seeking for fever, improve uptake of rapid diagnostic tests at the public and community levels and increase correct treatment of parasite-positive patients with ACT. Limited impact will be achieved if interventions to improve prompt and effective treatment target only one step in the treatment pathway in any sector.
目前，五岁以下发热儿童接受推荐的青蒿素联合疗法（ACT）的比例不足 15%，远低于抗击疟疾行动所设定的 80%的目标。为了解决覆盖率低的问题，我们需要从儿童发热开始，到接受适当治疗，对治疗途径进行详细的调查，并确定关键的障碍。本文介绍了在塞内加尔农村地区，应用这一诊断方法来评估儿童发热及时、有效治疗的覆盖率。
2008 年 8 月，在塞内加尔的坦巴昆达，进行了两阶段的聚类样本家庭调查，以了解过去两周内五岁以下发热儿童的治疗行为。将治疗途径分为五个关键步骤；计算每个步骤中所有发热儿童的比例。结果按提供者的部门（公共、社区和零售）进行分层。采用逻辑回归法确定寻求治疗的预测因素。
总的来说，61.6%（188 人）的照顾者寻求了任何建议或治疗，40.3%（123 人）在 48 小时内及时寻求了任何治疗。超过 70%的发热儿童在去任何有发热症状的提供者处没有得到抗疟治疗。从任何来源，在 48 小时内接受 ACT 的发热儿童比例为 6.2%（19 人）；如果包括正确的剂量和持续时间，这一比例将降至 1.3%。从公共提供者处获得 ACT 的发热儿童比例（不包括剂量和持续时间）为 3.0%（9 人），从社区来源获得 ACT 的发热儿童比例为 3.0%（9 人），从零售部门获得 ACT 的发热儿童比例为 0.3%（1 人）。如果按照国家政策，在公共部门的治疗途径中包括确诊诊断，那么从公共部门获得 ACT 的儿童的比例将从 9.4%（9/96）增加到估计的 20.0%（9/45）。
对发热儿童的治疗途径进行过程分析时，必须按治疗途径的部门进行分层。在坦巴昆达，需要采取干预措施，以增加对发热的及时护理，提高公共和社区层面快速诊断检测的利用率，并增加对寄生虫阳性患者使用 ACT 的正确治疗。如果仅针对任何部门的治疗途径中的一个步骤进行干预，以改善及时有效的治疗，那么效果将非常有限。
