Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
Malar J. 2011 Aug 3;10:218. doi: 10.1186/1475-2875-10-218.
Globally, the monitoring of prompt and effective treatment for malaria with artemisinin combination therapy (ACT) is conducted largely through household surveys. This measure; however, provides no information on case management processes at the health facility level. The aim of this review was to assess evidence from health facility surveys on malaria prescribing practices using ACT, in the presence and absence of ACT stock, at time and place where treatment was sought.
A systematic search of published literature was conducted. Findings were collated and data extracted on proportion of patients prescribed ACT and alternative anti-malarials in the presence and absence of ACT stock.
Of the 14 studies identified in which ACT prescription for uncomplicated malaria in the public sector was evaluated, just six, from three countries (Kenya, Uganda and Zambia), reported this in the context of ACT stock. Comparing facilities with ACT stock to facilities without stock (i) ACT prescribing was significantly higher in all six studies, increasing by a range of 21.3% in children < 5 yrs weighing ≥ 5 kg (p < 0.001; Kenya 2006) to 51.7% in children ≥ 10 kg (p < 0.001; Zambia 2006); (ii) SP prescribing decreased significantly in five studies, by a range of 14.4% (p < 0.001; Kenya 2006), to 46.3% (p < 0.001; Zambia 2006); (iii) Where quinine was a reported alternative, prescriptions decreased in five of the six studies by 0.1% (p = 1.0, Kenya 2010) to 10.2% (p < 0.001; Zambia 2006). At facilities with no ACT stock on the survey day, the proportion of febrile patients prescribed ACT was < 10% in five of the nine target groups included in the six studies, with the proportion prescribed ACT ranging from 0 to 28.4% (Uganda 2007).
Prescriber practices vary based on ACT availability. Although ACT prescriptions increased and alternative anti-malarials prescriptions decreased in the presence of ACT stock, ACT was prescribed in the absence, and alternative anti-malarials were prescribed in the presence of, ACT. Presence of stock alone does not ensure that treatment guidelines are followed. More health facility surveys, together with qualitative research, are needed to understand the role of ACT stock-outs on provider prescribing behaviours and preferences.
在全球范围内，通过家庭调查对采用青蒿素复方疗法（ACT）的疟疾进行及时有效的治疗监测。然而，这种方法并不能提供医疗机构层面的病例管理流程的信息。本综述旨在评估在寻求治疗的时间和地点，存在和不存在 ACT 库存的情况下，从医疗机构调查中获得的关于使用 ACT 治疗疟疾的处方实践的证据。
系统地检索了已发表的文献。对存在和不存在 ACT 库存的情况下，处方 ACT 和替代抗疟药物的患者比例，进行了研究结果的整理和数据提取。
在评估公共部门治疗无并发症疟疾时使用 ACT 的 14 项研究中，仅有 6 项（来自肯尼亚、乌干达和赞比亚三个国家）在 ACT 库存的背景下报告了这一情况。将有 ACT 库存的医疗机构与没有库存的医疗机构进行比较：（i）在所有六项研究中，ACT 处方的比例都显著增加，范围从体重≥5 公斤的＜5 岁儿童的 21.3%（p＜0.001；肯尼亚 2006 年）增加到 10 公斤以上儿童的 51.7%（p＜0.001；赞比亚 2006 年）；（ii）在五项研究中，SP 处方显著下降，范围从 14.4%（p＜0.001；肯尼亚 2006 年）下降到 46.3%（p＜0.001；赞比亚 2006 年）；（iii）在报告奎宁为替代药物的情况下，六项研究中有五项的处方下降了 0.1%（p=1.0，肯尼亚 2010 年）至 10.2%（p＜0.001；赞比亚 2006 年）。在调查日没有 ACT 库存的医疗机构中，在包括的六个研究中的九个目标人群中，有五个目标人群中发热患者处方 ACT 的比例＜10%，处方 ACT 的比例从 0 到 28.4%（乌干达 2007 年）。
处方医生的做法因 ACT 的可获得性而有所不同。尽管在有 ACT 库存的情况下，ACT 处方增加，替代抗疟药物处方减少，但在没有 ACT 的情况下，处方 ACT，在有 ACT 的情况下，处方替代抗疟药物。仅仅有库存并不能确保治疗指南得到遵循。需要进行更多的医疗机构调查，并结合定性研究，以了解 ACT 缺货对提供者处方行为和偏好的影响。
