Ewing Victoria L, Terlouw Dianne J, Kapinda Andrew, Pace Cheryl, Richards Esther, Tolhurst Rachel, Lalloo David G
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi.
Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK.
Malar J. 2015 Jan 21;14:13. doi: 10.1186/s12936-014-0528-8.
Adherence to anti-malarial dosing schedules is essential to ensure effective treatment. Measuring adherence is challenging due to recall issues and the participants' awareness of the desired behaviour influencing their actions or responses. This study used qualitative methods, which allow for rapport building, to explore issues around anti-malarial utilization in young children, and used the results to guide the development of a context specific questionnaire on perceptions and adherence to artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DHA-PPQ).
Qualitative data collection included 12 focus group discussions which explored community perceptions of anti-malarials and experiences of administering medications to children. Critical incidence interviews were conducted with 22 caregivers to explore experiences of administering the dispersible or original formulation of AL to young children during recent febrile episodes. A structured questionnaire was used to gather data on experience of recent treatment and adherence to anti-malarials during follow-up visits with 218 caregivers whose child was recently treated with either dispersible AL or DHA-PPQ.
DISCUSSION/CONCLUSION: Caregivers experience great difficulty in administering medication to children. While the sweet taste of dispersible AL may have reduced conflict between the child and caregiver, sub-optimal dosing due to medication loss remained a problem and overall adherence was greater among those receiving DHA-PPQ, which requires fewer doses. Some caregivers were found to deliberately alter the dosing schedule according to whether they perceived the medication to be too weak or strong. They also developed theories for poor treatment outcomes, such as attributing this to lack of compatibility between the medication and the child. Health education messages should be strengthened to ensure a combination of clear pictorial and verbal instructions are used during dispensing, and consequences of under and over-dosing are explained alongside appropriate responses to possible adverse events. Further optimizing of anti-malarial adherence among children requires the development of anti-malarials with pharmacological properties that allow user-friendly administration and simplified dosing schedules.
坚持抗疟药物给药方案对于确保有效治疗至关重要。由于回忆问题以及参与者对期望行为的认知会影响其行动或反应，测量依从性具有挑战性。本研究采用定性方法（该方法有助于建立融洽关系）来探讨幼儿抗疟药物使用方面的问题，并利用研究结果指导编制一份针对青蒿琥酯 - 阿莫地喹（AL）和双氢青蒿素 - 哌喹（DHA - PPQ）认知与依从性的特定背景调查问卷。
定性数据收集包括12次焦点小组讨论，探讨社区对抗疟药物的认知以及给儿童用药的经历。对22名照料者进行了关键事件访谈，以探讨在近期发热发作期间给幼儿服用AL分散片或原研剂型的经历。使用结构化问卷收集了218名照料者的数据，这些照料者的孩子最近接受了AL分散片或DHA - PPQ治疗，问卷内容涉及近期治疗经历以及随访期间对抗疟药物的依从性。
讨论/结论：照料者在给儿童用药方面遇到很大困难。虽然AL分散片的甜味可能减少了儿童与照料者之间的冲突，但由于药物损失导致的给药不足仍是一个问题，并且接受DHA - PPQ（所需剂量较少）的人群总体依从性更高。发现一些照料者会根据他们认为药物效力过弱或过强而故意改变给药方案。他们还为治疗效果不佳编造了一些说法，比如将其归因于药物与儿童不匹配。应加强健康教育信息，确保在配药时同时使用清晰的图片和文字说明，并解释给药不足和过量的后果以及对可能的不良事件的适当应对措施。进一步优化儿童抗疟药物依从性需要研发具有便于使用的给药特性和简化给药方案的抗疟药物。
