Institute of Medicine, Tribhuvan University, Kathmandu 44168, Nepal.
J Trop Med. 2012;2012:126093. doi: 10.1155/2012/126093. Epub 2012 May 9.
Background. National VL Elimination Programs in India, Nepal and Bangladesh face challenges as home-based Miltefosine treatment is introduced. Objectives. To study constraints of VL management in endemic districts within context of national elimination programs before and after intervention. Methods. Ninety-two and 41 newly diagnosed VL patients were interviewed for clinical and provider experience in 2009 before and in 2010 after intervention (district training and improved supply of diagnostics and drugs). Providers were assessed for adherence to treatment guidelines. Facilities and doctor-patient consultations were observed to assess quality of care. Results. Miltefosine use increased from 33% to 59% except in Nepal where amphotericin was better available. Incorrect dosage and treatment interruptions were rare. Advice on potential side effects was uncommon but improved significantly in 2010. Physicians did not rule out pregnancy prior to starting Miltefosine. Fever measurement or spleen palpation was infrequently done in Bangladesh but improved after intervention (from 23% to 47%). Physician awareness of renal or liver toxicity as Miltefosine side effects was lower in Bangladesh. Bio-chemical monitoring was uncommon. Patient satisfaction with services remained low for ease of access or time provider spent with patient. Health facilities were better stocked with rK39 kits and Miltefosine in 2010.
印度、尼泊尔和孟加拉国的国家淋巴丝虫病消除规划在引入家庭米替福新治疗方法后面临挑战。
在国家消除规划背景下，研究流行地区在干预前后治疗利什曼病的管理限制因素。
2009 年干预前和 2010 年干预后（地区培训和诊断及药物供应改善），对 92 名和 41 名新诊断的利什曼病患者进行了临床和医务人员经验访谈。评估医务人员对治疗指南的遵守情况。观察设施和医患咨询情况，评估护理质量。
米替福新的使用率从 33%上升到 59%，但在尼泊尔，两性霉素 B 的供应更好。剂量错误和治疗中断很少见。关于潜在副作用的建议并不常见，但在 2010 年显著改善。医生在开始使用米替福新之前没有排除怀孕的可能性。在孟加拉国，很少测量发热或脾脏触诊，但在干预后有所改善（从 23%增加到 47%）。孟加拉国医生对米替福新的肾或肝毒性作为副作用的认识较低。很少进行生化监测。患者对服务的满意度仍然较低，因为获取服务或提供者与患者在一起的时间困难。卫生设施在 2010 年更好地配备了 rK39 试剂盒和米替福新。
