基于家庭管理对尼日利亚一家三级医疗机构中五岁以下儿童疟疾治疗结果的影响。

Impact of home-based management on malaria outcome in under-fives presenting in a tertiary health institution in Nigeria.

作者信息

Nwaneri Damian U, Sadoh Ayebo E, Ibadin Michael O

机构信息

Department of Child Health, University of Benin Teaching Hospital, P.M.B. 1111, Benin City, Nigeria.

出版信息

Malar J. 2017 May 3;16(1):187. doi: 10.1186/s12936-017-1836-6.

DOI:10.1186/s12936-017-1836-6

PMID:28468628

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5415821/

Abstract

BACKGROUND

Home-based management of malaria involves prompt delivery of effective malaria treatment at the community by untrained caregiver. The aim of this study was to document home-based treatment of suspected malaria by non-medical caregivers and to identify its health impact on malaria outcome (severe malaria prevalence, parasite load and mortality) in children (6-59 months).

METHODS

A descriptive cross-sectional study carried out from June 2012-July 2013. Data was obtained by researcher-administered questionnaire and malaria was confirmed in each child by microscopy. Analysis was by Statistical Package for Scientific Solutions version 16.

RESULTS

Of the 290 caregivers (31.2 ± 6.1 years)/child (21.3 ± 14.4 months) pairs recruited, 222 (76.6%) caregivers managed malaria at home before presenting their children to hospital. Majority (99.0%) practiced inappropriate home-based malaria treatment. While only 35 (15.8%) caregivers used the recommended artemisinin-based combination therapy, most others used paracetamol either solely or in combination with anti-malarial monotherapy [153 (69.0%)]. There was no significant difference in mean [±] parasites count (2055.71 ± 1655.06/µL) of children who received home-based treatment and those who did not (2405.27 ± 1905.77/µL) (t = 1.02, p = 0.31). Prevalence of severe malaria in this study was 111 (38.3%), which was statistically significantly higher in children who received home-based malaria treatment [90.0%] (χ = 18.4, OR 4.2, p = 0.00). The mortality rate was 62 per 1000 and all the children that died received home-based treatment (p < 0.001). While low socio-economic class was the significant predictor of prevalence of severe malaria (β = 0.90, OR 2.5, p = 0.00), late presentation significantly predicted mortality (β = 1.87, OR 6.5, p = 0.02).

CONCLUSIONS

The expected benefits of home-based management of malaria in under-fives were undermined by inappropriate treatment practices by the caregivers leading to high incidence of severe malaria and mortality.

摘要

背景

疟疾的家庭管理涉及由未经培训的照料者在社区迅速提供有效的疟疾治疗。本研究的目的是记录非医疗照料者对疑似疟疾的家庭治疗情况，并确定其对6至59个月儿童疟疾结局（严重疟疾患病率、寄生虫载量和死亡率）的健康影响。

方法

2012年6月至2013年7月进行了一项描述性横断面研究。通过研究人员发放的问卷获取数据，每个儿童的疟疾通过显微镜检查确诊。使用科学解决方案统计软件包第16版进行分析。

结果

在招募的290名照料者（年龄31.2±6.1岁）/儿童（年龄21.3±14.4个月）对中，222名（76.6%）照料者在带孩子去医院之前在家中管理疟疾。大多数（99.0%）实施了不恰当的家庭疟疾治疗。只有35名（15.8%）照料者使用了推荐的以青蒿素为基础的联合疗法，其他大多数人单独使用对乙酰氨基酚或与抗疟疾单一疗法联合使用[153名（69.0%）]。接受家庭治疗的儿童与未接受家庭治疗的儿童的平均[±]寄生虫计数（2055.71±1655.06/微升）无显著差异（t=1.02，p=0.31）。本研究中严重疟疾的患病率为111例（38.3%），在接受家庭疟疾治疗的儿童中[90.0%]在统计学上显著更高（χ=18.4，OR 4.2，p=0.00）。死亡率为每1000例62例，所有死亡儿童均接受了家庭治疗（p<0.001）。虽然低社会经济阶层是严重疟疾患病率的显著预测因素（β=0.90，OR 2.5，p=0.00），但就诊延迟显著预测死亡率（β=1.87，OR 6.5，p=0.02）。