Elmannan Abeer Abuzeid Atta, Elmardi Khalid Abdelmutalab, Idris Yassir Ali, Spector Jonathan M, Ali Nahid Abdelgadir, Malik Elfatih Mohamed
Al Neelain University, Steen Street, P.O. Box 7294, Code: 11123, Khartoum, Sudan.
Federal Ministry of Health, Khartoum, Sudan.
BMC Pharmacol Toxicol. 2015 Mar 26;16:3. doi: 10.1186/s40360-015-0002-4.
The World Health Organization (WHO) recommends artemisinin-based combination therapies (ACTs) as first-line treatment for uncomplicated malaria. Sudan revised its malaria treatment policy accordingly in 2004. However, eight years after ACTs were introduced in Sudan the patterns of ACT prescribing practices among health care providers remain unclear. We systematically analyzed use of ACTs in a large number of primary health facilities and we discuss the public health implications of our findings.
This cross-sectional study was based on WHO's guidance for investigating drug use in health facilities. Data were collected from 40 randomly selected primary health centers in five localities in Gezira State, Sudan. The primary outcome of the study was the proportion of patients who were adequately managed according to Sudan's recommended malaria treatment guidelines. Twelve drug-use indicators were used to assess key ACT prescribing practices.
One thousand and two hundred patients diagnosed with uncomplicated malaria were recruited into the study. ACT was prescribed for 88.6%patients and artemether injections were (incorrectly) prescribed in 9.5% of cases. Only 40.9% of patients in the study were correctly diagnosed and 26.9% were adequately managed according to the nationally recommended treatment guidelines. Incorrect prescribing activities included failure to use generic medicine names (88.2%), incorrect dosage (27.7%), and unexplained antibiotic co-prescription (24.2%). Dispensing practices were also poor, with labeling practices inadequate (97.1%) and insufficient information given to patients about their prescribed treatment (50.5%).
Irrational malaria treatment practices are common in Sudan. This has important public health implications since failure to adhere to nationally recommended guidelines could play a role in the future development of drug resistance. As such, identifying ways to improve the anti-malarial prescribing practices of heath workers in Sudan may be a priority.
世界卫生组织（WHO）推荐以青蒿素为基础的联合疗法（ACTs）作为非复杂性疟疾的一线治疗方法。苏丹于2004年相应修订了其疟疾治疗政策。然而，在苏丹引入ACTs八年后，医疗保健提供者中ACTs的处方模式仍不明确。我们系统分析了大量初级卫生设施中ACTs的使用情况，并讨论了我们研究结果对公共卫生的影响。
这项横断面研究基于WHO关于调查卫生设施中药物使用的指南。数据收集自苏丹杰济拉州五个地区随机选择的40个初级卫生中心。该研究的主要结果是根据苏丹推荐的疟疾治疗指南得到妥善治疗的患者比例。使用12个药物使用指标来评估ACTs的关键处方做法。
1200名被诊断为非复杂性疟疾的患者被纳入研究。88.6%的患者接受了ACTs治疗，9.5%的病例（错误地）开具了蒿甲醚注射液。根据国家推荐的治疗指南，该研究中只有40.9%的患者得到正确诊断，26.9%的患者得到妥善治疗。不正确的处方行为包括未使用通用药品名称（88.2%）、剂量不正确（27.7%）以及无法解释的抗生素联合处方（24.2%）。配药做法也很差，标签做法不完善（97.1%），并且向患者提供的关于其处方治疗的信息不足（50.5%）。
不合理的疟疾治疗做法在苏丹很常见。这具有重要的公共卫生影响，因为不遵守国家推荐的指南可能在未来耐药性的发展中起作用。因此，确定改善苏丹卫生工作者抗疟疾处方做法的方法可能是当务之急。
