Institut de Francophonie pour Médecine Tropicale, Vientiane, BP 9519, Lao PDR.
Malar J. 2010 Dec 1;9:347. doi: 10.1186/1475-2875-9-347.
Early diagnosis and treatment (EDAT) is crucial to reducing the burden of malaria in low-income countries. In the Lao PDR, this strategy was introduced in 2004-2005 and an assessment was performed at the community level in January 2007.
EDAT with malaria rapid diagnostic test (MRDT) and artemisinin combination therapy (ACT) was prospectively assessed among 36 randomized village health volunteers (VHVs) and 720 patients in six malaria-endemic provinces of Laos (three pilot provinces (PP), and three non-pilots provinces (NPP)). ACT was also retrospectively assessed among 2188 patients within the same areas from June to November 2006. Two checklists were used and scores were calculated.
EDAT performance of the VHVs was rated better in PP than in NPP (16.67% versus 38.89%, respectively, p = 0.004). Nearly all VHVs could diagnose malaria but only 16 (44%) could describe the symptoms of severe malaria. In January 2007, 31/720 (4%) patients tested positive using the Paracheck test, 35 (5%) with microscopy (sensibility: 74.3%, specificity 99.3%, positive and negative predictive values: 83.9% and 98.7%, respectively). Patients from June to November were at higher risk of malaria: 35.19% of 2,188 febrile patients were positive (OR: 10.6, 95%CI: 7.4-15.5, p < 0.000). VHVs reported the MRDT easy to use, and yielded a satisfactory performance score. EDAT performance was rated as poor despite satisfactory results regarding ACT treatment, duration and dosages. Pre-referral treatment of severe malaria was infrequent and often inadequate, with 20% of these patients dying. Results suggest a higher mortality from severe malaria than officially reported. Shortage of ACT was frequent.
MRDT and ACT are useful and efficient and can be used by VHVs. VHVs' global EDAT performance is enhanced through training and monitoring. Persistent gaps in knowledge, care of patients and wrong treatment have to be addressed.
早期诊断和治疗（EDAT）对于减轻低收入国家的疟疾负担至关重要。在老挝人民民主共和国，该策略于 2004-2005 年推出，并于 2007 年 1 月在社区层面进行了评估。
在老挝六个疟疾流行省份（三个试点省（PP）和三个非试点省（NPP）），对 36 名随机分配的乡村卫生志愿者（VHVs）和 720 名患者进行了疟疾快速诊断检测（MRDT）和青蒿素联合疗法（ACT）的前瞻性评估。还对 2006 年 6 月至 11 月在同一地区的 2188 名患者进行了回顾性评估。使用了两份检查表并计算了分数。
VHVs 的 EDAT 表现评价在 PP 省优于 NPP 省（分别为 16.67%和 38.89%，p=0.004）。几乎所有 VHVs 都能诊断疟疾，但只有 16 人（44%）能够描述严重疟疾的症状。2007 年 1 月，720 名患者中有 31 名（4%）用 Paracheck 检测呈阳性，35 名（5%）用显微镜检查（敏感性：74.3%，特异性 99.3%，阳性和阴性预测值分别为 83.9%和 98.7%）。6 月至 11 月期间，发热患者患疟疾的风险更高：2188 名发热患者中，有 35.19%（35.19%）呈阳性（OR：10.6，95%CI：7.4-15.5，p<0.000）。VHVs 报告说，MRDT 易于使用，并且产生了令人满意的性能得分。尽管 ACT 治疗、持续时间和剂量方面的结果令人满意，但 EDAT 的表现仍被评为不佳。严重疟疾的预转诊治疗不常见且往往不足，其中 20%的患者死亡。结果表明，严重疟疾的死亡率高于官方报告。ACT 的短缺也很常见。
MRDT 和 ACT 既有用又有效，VHVs 可以使用。通过培训和监测，增强了 VHVs 的整体 EDAT 表现。必须解决知识、患者护理和错误治疗方面的持续差距。
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