Saweri Olga P M, Hetzel Manuel W, Mueller Ivo, Siba Peter M, Pulford Justin
Papua New Guinea Institute of Medical Research (PNGIMR), PO Box 60, Goroka, EHP 441, Papua New Guinea.
Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland.
BMC Health Serv Res. 2017 Jan 5;17(1):10. doi: 10.1186/s12913-016-1965-6.
The Papua New Guinea Department of Health recently shifted from a presumptive to a 'test and treat' malaria case management policy. This shift was supported by the widespread introduction of malaria rapid diagnostic tests in health facilities across the country. Health workers received training and job-aids detailing how to conduct and interpret a malaria rapid diagnostic test and how to treat test positive cases; however, little instruction on treating non-malaria febrile cases was provided. Accordingly, this study examined health worker case management of non-malarial febrile patients in the 12-month period immediately following the introduction of the revised malaria case management policy.
Data were collected from a country-wide cross-sectional survey of febrile case management at randomly selected health facilities and from longitudinal surveillance at sentinel health facilities. Analysis was restricted to febrile patients who tested negative for malaria infection by rapid diagnostic test (N=303 and 5705 outpatients, respectively).
96.8% of non-malarial febrile patients received a diagnosis in the longitudinal sample, compared to 52.4% of the cross-sectional sample. Respiratory tract infections were the most commonly reported diagnoses. Over 90% of patients in both samples were prescribed one or more medications, most commonly an analgesic (71.3 & 72.9% of the longitudinal and cross-sectional samples, respectively), some form of antibiotic (72.7 & 73.4%, respectively) and/or an anthelminthic (17.9 & 16.5%, respectively). Prescribing behaviour was adherent with the recommendations in the standard treatment guidelines in fewer than 20% of cases (longitudinal sample only).
Many non-malarial febrile patients are not provided with a diagnosis. When diagnoses are provided they are typically some form of respiratory tract infection. Antibiotics and analgesics are widely prescribed, although medications prescribed rarely adhere to the Papua New Guinea standard treatment guidelines. These findings indicate that Papua New Guinea health workers require support for non-malarial febrile illness case management.
巴布亚新几内亚卫生部最近从推定治疗的疟疾病例管理政策转向了“检测与治疗”政策。这一转变得到了全国卫生机构广泛引入疟疾快速诊断检测的支持。卫生工作者接受了培训并获得了工作辅助工具，详细说明了如何进行和解读疟疾快速诊断检测以及如何治疗检测呈阳性的病例；然而，关于治疗非疟疾发热病例的指导却很少。因此，本研究调查了在修订后的疟疾病例管理政策实施后的12个月内，卫生工作者对非疟疾发热患者的病例管理情况。
数据收集自对随机选择的卫生机构进行的全国发热病例管理横断面调查以及哨点卫生机构的纵向监测。分析仅限于通过快速诊断检测疟疾感染呈阴性的发热患者（分别为303名和5705名门诊患者）。
在纵向样本中，96.8%的非疟疾发热患者得到了诊断，而横断面样本中的这一比例为52.4%。呼吸道感染是最常报告的诊断结果。两个样本中超过90%的患者都被开具了一种或多种药物，最常见的是镇痛药（纵向样本和横断面样本中分别为71.3%和72.9%）、某种形式的抗生素（分别为72.7%和73.4%）和/或驱虫药（分别为17.9%和16.5%）。在不到20%的病例中（仅纵向样本），开药行为符合标准治疗指南中的建议。
许多非疟疾发热患者未得到诊断。当做出诊断时，通常是某种形式的呼吸道感染。抗生素和镇痛药被广泛开具，尽管所开药物很少符合巴布亚新几内亚的标准治疗指南。这些发现表明，巴布亚新几内亚的卫生工作者在非疟疾发热疾病病例管理方面需要支持。
