Mawili-Mboumba Denise Patricia, Bouyou-Akotet Marielle Karine, Kombila Maryvonne
Université des Sciences de la Santé Faculté de Médecine Département de Parasitologie-Mycologie BP 4009, Libreville Gabon.
Sante. 2011 Jul-Sep;21(3):127-31. doi: 10.1684/san.2011.0267.
Resistance by Plasmodium falciparum to antimalarial drugs has strongly hampered strategies for malaria control and elimination. Therefore, one of the goals of the World Health Organisation's new malaria control strategies is the rational and appropriate use of antimalarial drugs and in particular of artemisinin-based combination therapy (ACTs), currently used for the treatment of uncomplicated malaria; in order to delay the appearance of drug-resistant parasites. The unprescribed use of antimalarial drugs (self medication and parental administration to children) is a key component in the development of antimalarial drug resistance and must be controlled among patients living in malaria-endemic areas. The aim of our study was to estimate the frequency of this parental administration among febrile children and to identify the specific drugs used. Data were collected in two studies evaluating the proportion of malaria cases and the performance of rapid drug tests among febrile children seen in 2008-2009 at 3 hospitals, one in a rural area, one in an urban area, and the third in a semi-urban area. This parental medication administration was found among 21.4% of the 2543 children included in the studies. It was most common at the rural hospital (29%), which is also where malaria prevalence was highest (39%). Of the 548 children "medicated", 421, that is, almost 80%, were not infected. The antimalarial drugs used most frequently were ACTs (43.8%) and quinine (12%). In Gabon, as in other sub-Saharan countries, use of antimalarial drugs before consultation is common and is an obstacle to malaria control. Therefore, improving the rational use of these drugs by the population requires active outreach to the community about the risks of unprescribed medication.
恶性疟原虫对抗疟药物产生的耐药性严重阻碍了疟疾控制和消除策略的实施。因此，世界卫生组织新疟疾控制策略的目标之一是合理、恰当地使用抗疟药物，尤其是目前用于治疗非复杂性疟疾的青蒿素联合疗法（ACTs），以延缓耐药寄生虫的出现。抗疟药物的非处方使用（自我用药以及给儿童家长给药）是抗疟药物耐药性产生的一个关键因素，必须在疟疾流行地区的患者中加以控制。我们研究的目的是估计发热儿童中家长给药的频率，并确定所使用的具体药物。数据收集于两项研究，这两项研究评估了2008 - 2009年在3家医院就诊的发热儿童中的疟疾病例比例以及快速药物检测的性能，其中一家在农村地区，一家在城市地区，第三家在半城市地区。在所纳入研究的2543名儿童中，有21.4%发现存在这种家长给药情况。这种情况在农村医院最为常见（29%），而农村医院也是疟疾患病率最高的地方（39%）。在548名“接受药物治疗”的儿童中，有421名，即近80%，并未感染。最常使用的抗疟药物是ACTs（43.8%）和奎宁（12%）。在加蓬，与其他撒哈拉以南国家一样，在咨询前使用抗疟药物的情况很普遍，这是疟疾控制的一个障碍。因此，要提高民众对这些药物的合理使用，就需要积极向社区宣传非处方用药的风险。
