Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
BMC Health Serv Res. 2012 Jun 8;12:146. doi: 10.1186/1472-6963-12-146.
Prompt access to artemesinin-combination therapy (ACT) is not adequate unless the drug is taken according to treatment guidelines. Adherence to the treatment schedule is important to preserve efficacy of the drug. Although some community based studies have reported fairly high levels of adherence, data on factors influencing adherence to artemether-lumefantrine (AL) treatment schedule remain inadequate. This study was carried-out to explore the provider's instructions to caretakers, caretakers' understanding of the instructions and how that understanding was likely to influence their practice with regard to adhering to AL treatment schedule.
A qualitative study was conducted in five villages in Kilosa district, Tanzania. In-depth interviews were held with providers that included prescribers and dispensers; and caretakers whose children had just received AL treatment. Information was collected on providers' instructions to caretakers regarding dose timing and how to administer AL; and caretakers' understanding of providers' instructions.
Mismatch was found on providers' instructions as regards to dose timing. Some providers' (dogmatists) instructions were based on strict hourly schedule (conventional) which was likely to lead to administering some doses in awkward hours and completing treatment several hours before the scheduled time. Other providers (pragmatists) based their instruction on the existing circumstances (contextual) which was likely to lead to delays in administering the initial dose with serious treatment outcomes. Findings suggest that, the national treatment guidelines do not provide explicit information on how to address the various scenarios found in the field. A communication gap was also noted in which some important instructions on how to administer the doses were sometimes not provided or were given with false reasons.
There is need for a review of the national malaria treatment guidelines to address local context. In the review, emphasis should be put on on-the-job training to address practical problems faced by providers in the course of their work. Further research is needed to determine the implication of completing AL treatment prior to scheduled time.
除非按照治疗指南服用，否则无法及时获得青蒿素类复方疗法（ACT），而按时服药对于保证药物疗效非常重要。尽管一些社区基础研究报告了相当高的服药依从率，但关于影响青蒿琥酯-咯萘啶（AL）治疗方案依从性的因素的数据仍然不足。本研究旨在探索提供者向看护人提供的医嘱、看护人对医嘱的理解以及这种理解如何影响他们遵守 AL 治疗方案的实践。
在坦桑尼亚基利萨地区的五个村庄进行了一项定性研究。对包括处方者和配药者在内的提供者以及刚刚接受 AL 治疗的儿童的看护人进行了深入访谈。收集了提供者关于剂量时间和如何使用 AL 向看护人提供的医嘱信息，以及看护人对提供者医嘱的理解。
在剂量时间方面，发现提供者的医嘱存在差异。一些提供者（教条主义者）的医嘱基于严格的小时时间表（常规），这可能导致在尴尬的时间服用一些剂量，并在预定时间之前几个小时完成治疗。其他提供者（实用主义者）则根据现有情况（情境）来制定医嘱，这可能导致初始剂量的延迟，从而产生严重的治疗后果。研究结果表明，国家治疗指南没有明确说明如何处理在实地发现的各种情况。还注意到存在沟通差距，一些关于如何给药的重要医嘱有时没有提供，或者提供的理由是错误的。
需要对国家疟疾治疗指南进行审查，以解决当地情况。在审查中，应强调在职培训，以解决提供者在工作过程中面临的实际问题。还需要进一步研究提前完成 AL 治疗的影响。
