Ndong Ignatius C, Reenen Mari van, Boakye Daniel A, Mbacham Wilfred F, Grobler Anne F
DST/NWU, Preclinical Drug Development Platform, North-West University, Potchefstroom Campus, South Africa; Department of Biochemistry, Catholic University of Cameroon, Bamenda, Cameroon; Laboratory of Public Health Research Biotechnologies, University of Yaoundé I, Cameroon.
Statistical Consultation Services, North-West University, Potchefstroom Campus, South Africa.
Acta Trop. 2015 Oct;150:100-6. doi: 10.1016/j.actatropica.2015.06.014. Epub 2015 Jun 18.
National malaria treatment policies are devised to guide health professionals and to facilitate diagnosis and case management. Following the recommendations of the WHO, Cameroon changed its malaria treatment policy from monotherapy to artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria. We report an investigation into trends of case management following this change in policy. Data was collected retrospectively, through consultation and perusal of laboratory and prescription registers of the Mbakong Health Centre. Analysis of data was done using SPSS and SAS Statistics. Data presented herein demonstrate that from 2006 to 2012, a total of 2484 (58.7%) of the total prescriptions included an anti-malarial, 1989 (47.0%) included an antibiotic and 1935(45.7%) included an antipyretic. The anti-malarials prescribed were Anti-malaria combination therapy (ACT) - 1216 (47.6%), quinine 1044 (40.8%) or SP 296 (11.6%). Of the 1216 patients prescribed an ACT, 441(36.3%) had a positive malaria parasite confirmation, 746 (61.3%) were negative for plasmodium. Overall, 29 patients (2.4%) were treated either with an ACT without any test performed. Quinine intake was recorded in 566 (54.2%) patients positive for plasmodium. ACT prescription increased from 23% in 2007 to between 44 and 45% in 2008-2009. During this period there was a corresponding drop in the prescription of quinine from 38% in 2007 to 13% in 2009 (r=-0.43, p>0.05). Sulphadoxine-Pyrimethamine (SP) was restrictively prescribed to women of childbearing age (97.0%) after 2008. Antibiotics prescription dropped from 53.7% to 39.3% from 2010 to 2012. The odds of being prescribed an antibiotic was significantly higher in patients with a malaria negative result compared to malaria positive patients (OR=6.12, CI 4.74-7.91, p<0.00001). Overall, there is an over treatment of malaria, thus departing from the WHO guidelines of appropriate treatment. Although there is an overall increase in the prescription of ACT, less prescription of quinine and a noticeable restrain from prescription of SP to febrile cases, the old practice was still rampant. There is need for healthcare workers to adhere to guidelines in order to enhance the rational use of drugs to achieve appropriate treatment of uncomplicated malaria according to WHO guidelines.
制定国家疟疾治疗政策是为了指导卫生专业人员并促进诊断和病例管理。根据世界卫生组织的建议，喀麦隆将其疟疾治疗政策从单一疗法改为以青蒿素为基础的联合疗法（ACT），作为单纯性疟疾的一线治疗方法。我们报告了一项关于政策变化后病例管理趋势的调查。数据通过咨询和查阅姆巴孔健康中心的实验室和处方登记册进行回顾性收集。使用SPSS和SAS统计软件进行数据分析。本文呈现的数据表明，2006年至2012年期间，总处方中共有2484份（58.7%）包含抗疟药，1989份（47.0%）包含抗生素，1935份（45.7%）包含退烧药。所开的抗疟药为抗疟疾联合疗法（ACT）——1216份（47.6%）、奎宁1044份（40.8%）或磺胺多辛-乙胺嘧啶（SP）296份（11.6%）。在1216名开具ACT的患者中，441名（36.3%）疟原虫确诊为阳性，746名（61.3%）疟原虫检测为阴性。总体而言，29名患者（2.4%）在未进行任何检测的情况下接受了ACT治疗。在疟原虫检测呈阳性的患者中，有566名（54.2%）记录了奎宁的服用情况。ACT处方从2007年的23%增加到2008 - 2009年的44%至45%。在此期间，奎宁处方相应地从2007年的38%降至2009年的13%（r = -0.43，p>0.05）。2008年后，磺胺多辛-乙胺嘧啶（SP）仅限制性地开给育龄妇女（97.0%）。抗生素处方从2010年到2012年从53.7%降至39.3%。与疟原虫检测呈阳性的患者相比，疟原虫检测呈阴性的患者开具抗生素的几率显著更高（OR = 6.12，CI 4.74 - 7.91，p<0.00001）。总体而言，存在疟疾过度治疗的情况，因此背离了世界卫生组织的适当治疗指南。尽管ACT处方总体上有所增加，奎宁处方减少，并且对发热病例开具SP的情况有明显限制，但旧的做法仍然很普遍。医护人员需要遵守指南，以加强药物的合理使用，按照世界卫生组织的指南实现对单纯性疟疾的适当治疗。
