改善疟疾的合理治疗：尼日利亚东南部卫生工作者对 RDT 的认知及其对处方行为的影响。
Improving rational treatment of malaria: perceptions and influence of RDTs on prescribing behaviour of health workers in southeast Nigeria.
机构信息
Department of Community Medicine, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria.
出版信息
PLoS One. 2011 Jan 31;6(1):e14627. doi: 10.1371/journal.pone.0014627.
INTRODUCTION
Developments in rapid diagnostic tests (RDTs) have opened new possibilities for improved remote malaria diagnosis that is independent of microscopic diagnosis. Studies in some settings have tried to assess the influence of RDTs on the prescribing behaviour of health workers, but such information is generally lacking in Nigeria and many parts of sub-Saharan Africa. This study analysed health workers' perceptions of RDTs and their potential influence on their prescribing and treatment practices after their introduction.
METHODS
The study was conducted in four health centers in the Enugu East local government of Enugu State, Nigeria. All 32 health workers in the health centers where RDTs were deployed were interviewed by field workers. Information was sought on their perception of symptoms-based, RDT-based, and microscopy-based malaria diagnoses. In addition, prescription analysis was carried out on 400 prescriptions before and 12 months after RDT deployment.
RESULTS
The majority of the health workers perceived RDTs to be more effective for malaria diagnosis than microscopy and clinical diagnosis. They also felt that the benefits of RDTs included increased use of RDTs in the facilities and the tendency to prescribe more Artemisinin-based combination therapies (ACTs) and less chloroquine and SP. Some of the health workers experienced some difficulties in the process of using RDT kits. ACTs were prescribed in 74% of RDT-negative results.
CONCLUSIONS/SIGNIFICANCE: RDT-supported malaria diagnosis may have led to the overprescription of ACTs, with the drug being prescribed to people with RDT-negative results. However, the prescription of other antimalarial drugs that are not first-line drugs has been reduced. Efforts should be made to encourage health workers to trust RDT results and prescribe ACTs only to those with positive RDT results. In-depth studies are needed to determine why health workers continue to prescribe ACTs in RDT-negative results.
简介
快速诊断检测（RDT）的发展为改善依赖显微镜诊断的远程疟疾诊断开辟了新的可能性。在某些环境中已经有研究试图评估 RDT 对卫生工作者处方行为的影响，但在尼日利亚和撒哈拉以南非洲的许多地区，这种信息通常是缺乏的。本研究分析了卫生工作者对 RDT 的看法，以及引入 RDT 后对其处方和治疗实践的潜在影响。
方法
本研究在尼日利亚埃努古州埃努古东地方政府的四个卫生中心进行。对部署 RDT 的卫生中心的所有 32 名卫生工作者进行了现场工作人员访谈。调查了他们对基于症状、基于 RDT 和基于显微镜的疟疾诊断的看法。此外，在部署 RDT 前后对 400 张处方进行了处方分析。
结果
大多数卫生工作者认为 RDT 比显微镜和临床诊断更有效。他们还认为 RDT 的好处包括设施中更多地使用 RDT，以及倾向于开更多的青蒿素为基础的联合疗法（ACT）和更少的氯喹和 SP。一些卫生工作者在使用 RDT 试剂盒的过程中遇到了一些困难。在 RDT 阴性结果中，74%的情况下开了 ACT。
结论/意义：RDT 支持的疟疾诊断可能导致过度处方 ACT，即使 RDT 结果为阴性也开了该药。然而，其他非一线药物的抗疟药物的处方已经减少。应努力鼓励卫生工作者信任 RDT 结果，只开 ACT 给 RDT 阳性结果的人。需要进行深入研究，以确定为什么卫生工作者在 RDT 阴性结果中继续开 ACT。
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