Kassam Rosemin, Sekiwunga Richard, Collins John B, Tembe Juliet, Liow Eric
School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada.
Child Health and Development Centre, School of Medicine, Makerere University, P.O. Box 7062, Kampala, Uganda.
BMC Infect Dis. 2016 Sep 6;16(1):478. doi: 10.1186/s12879-016-1815-5.
This study responds to a rural community's concern that, despite national initiatives, malaria management in young children falls short of national guidelines in their district. This study aimed to: (1) describe caregivers' treatment-seeking behaviors in the rural district of Butaleja, (2) estimate the percentage of children who received an appropriate antimalarial, and (3) determine factors that maximized the likelihood of receiving an appropriate antimalarial. Appropriate antimalarial in this study is defined as having received only the Uganda's age-specific first-line malaria treatment for uncomplicated and severe malaria during the course of the febrile illness.
A household survey design was used in 2011 to interview 424 caregivers with a child aged five and under who had fever within the two weeks preceding the survey. The survey evaluated factors that included: knowledge about malaria and its treatment, management practices, decision-making, and access to artemisinin combination therapy (ACT) and information sources. Bivariate analysis, followed by logistic regression, was used to determine predictors of the likelihood of receiving an appropriate antimalarial.
Home management was the most common first action, with most children requiring a subsequent action to manage their fever. Overall, 20.9 % of children received a blood test, 68.4 % received an antimalarial, and 41.0 % received an ACT. But closer inspection showed that only 31.6 % received an appropriate antimalarial. These results confirm that ACT usage and receipt of an appropriate antimalarial in Butaleja remain well below the 2010/2015 target of 85 %. While nine survey items differentiated significantly whether a child had or had not received an appropriate antimalarial, our logistic regression model identified four items as independent predictors of likelihood that a child would receive an appropriate antimalarial: obtaining antimalarials from regulated outlets (OR = 14.99); keeping ACT in the home for future use (OR = 6.36); reporting they would select ACT given the choice (OR = 2.31); and child's age older than four months (OR = 5.67).
Few children in Butaleja received malaria treatment in accordance with national guidelines. This study highlighted the importance of engaging the full spectrum of stakeholders in the management of malaria in young children - including licensed and unlicensed providers, caregivers, and family members.
本研究回应了一个农村社区的担忧，即尽管有国家倡议，但该地区幼儿疟疾管理仍未达到国家指南的要求。本研究旨在：（1）描述布塔莱贾农村地区照顾者的就医行为，（2）估计接受适当抗疟治疗的儿童百分比，以及（3）确定使接受适当抗疟治疗可能性最大化的因素。本研究中适当的抗疟治疗定义为在发热疾病过程中仅接受乌干达针对非重症和重症疟疾的特定年龄一线疟疾治疗。
2011年采用家庭调查设计，对424名照顾者进行访谈，这些照顾者的孩子年龄在5岁及以下，且在调查前两周内发烧。该调查评估了以下因素：对疟疾及其治疗的了解、管理做法、决策过程以及获得青蒿素联合疗法（ACT）的情况和信息来源。采用双变量分析，随后进行逻辑回归，以确定接受适当抗疟治疗可能性的预测因素。
家庭管理是最常见的首要行动，大多数儿童需要后续行动来处理发烧。总体而言，20.9%的儿童接受了血液检测，68.4%的儿童接受了抗疟治疗，41.0%的儿童接受了ACT。但仔细检查发现，只有31.6%的儿童接受了适当的抗疟治疗。这些结果证实，布塔莱贾的ACT使用情况和接受适当抗疟治疗的比例仍远低于2010/2015年85%的目标。虽然有九个调查项目在区分儿童是否接受了适当抗疟治疗方面有显著差异，但我们的逻辑回归模型确定了四个项目是儿童接受适当抗疟治疗可能性的独立预测因素：从正规渠道获得抗疟药物（比值比=14.99）；家中备有ACT以供未来使用（比值比=6.36）；报告如果有选择会选择ACT（比值比=2.31）；以及儿童年龄大于四个月（比值比=5.67）。
布塔莱贾很少有儿童按照国家指南接受疟疾治疗。本研究强调了让所有利益相关者参与幼儿疟疾管理的重要性，这些利益相关者包括有执照和无执照的提供者、照顾者和家庭成员。
