评估安哥拉两个省份公共卫生机构的疟疾病例管理情况。
Evaluating malaria case management at public health facilities in two provinces in Angola.
作者信息
Plucinski Mateusz M, Ferreira Manzambi, Ferreira Carolina Miguel, Burns Jordan, Gaparayi Patrick, João Lubaki, da Costa Olinda, Gill Parambir, Samutondo Claudete, Quivinja Joltim, Mbounga Eliane, de León Gabriel Ponce, Halsey Eric S, Dimbu Pedro Rafael, Fortes Filomeno
机构信息
Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.
President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, GA, USA.
出版信息
Malar J. 2017 May 3;16(1):186. doi: 10.1186/s12936-017-1843-7.
BACKGROUND
Malaria accounts for the largest portion of healthcare demand in Angola. A pillar of malaria control in Angola is the appropriate management of malaria illness, including testing of suspect cases with rapid diagnostic tests (RDTs) and treatment of confirmed cases with artemisinin-based combination therapy (ACT). Periodic systematic evaluations of malaria case management are recommended to measure health facility readiness and adherence to national case management guidelines.
METHODS
Cross-sectional health facility surveys were performed in low-transmission Huambo and high-transmission Uíge Provinces in early 2016. In each province, 45 health facilities were randomly selected from among all public health facilities stratified by level of care. Survey teams performed inventories of malaria commodities and conducted exit interviews and re-examinations, including RDT testing, of a random selection of all patients completing outpatient consultations. Key health facility readiness and case management indicators were calculated adjusting for the cluster sampling design and utilization.
RESULTS
Availability of RDTs or microscopy on the day of the survey was 71% (54-83) in Huambo and 85% (67-94) in Uíge. At least one unit dose pack of one formulation of an ACT (usually artemether-lumefantrine) was available in 83% (66-92) of health facilities in Huambo and 79% (61-90) of health facilities in Uíge. Testing rates of suspect malaria cases in Huambo were 30% (23-38) versus 69% (53-81) in Uíge. Overall, 28% (13-49) of patients with uncomplicated malaria, as determined during the re-examination, were appropriately treated with an ACT with the correct dose in Huambo, compared to 60% (42-75) in Uíge. Incorrect case management of suspect malaria cases was associated with lack of healthcare worker training in Huambo and ACT stock-outs in Uíge.
CONCLUSIONS
The results reveal important differences between provinces. Despite similar availability of testing and ACT, testing and treatment rates were lower in Huambo compared to Uíge. A majority of true malaria cases seeking care in health facilities in Huambo were not appropriately treated with anti-malarials, highlighting the importance of continued training and supervision of healthcare workers in malaria case management, particularly in areas with decreased malaria transmission.
背景
疟疾在安哥拉的医疗需求中占比最大。安哥拉疟疾防控的一个支柱是对疟疾疾病进行适当管理，包括使用快速诊断检测（RDT）对疑似病例进行检测，以及使用以青蒿素为基础的联合疗法（ACT）对确诊病例进行治疗。建议定期对疟疾病例管理进行系统评估，以衡量医疗机构的准备情况和对国家病例管理指南的遵守情况。
方法
2016年初，在疟疾低传播地区的万博省和高传播地区的威热省开展了横断面医疗机构调查。在每个省份，从所有按护理级别分层的公共卫生机构中随机抽取45家医疗机构。调查团队对疟疾用品进行了清点，并对所有完成门诊咨询的患者进行随机抽样，进行了出院访谈和复查，包括RDT检测。计算关键的医疗机构准备情况和病例管理指标，并针对整群抽样设计和利用率进行调整。
结果
在调查当天，万博省RDT或显微镜检查的可获得率为71%（54 - 83），威热省为85%（67 - 94）。万博省83%（66 - 92）的医疗机构至少有一个单位剂量包装的一种ACT制剂（通常是蒿甲醚 - 本芴醇），威热省为79%（61 - 90）。万博省疑似疟疾病例的检测率为30%（23 - 38），而威热省为69%（53 - 81）。总体而言，在复查中确定为非重症疟疾的患者中，万博省有28%（13 - 49）接受了正确剂量的ACT适当治疗，而威热省为60%（42 - 75）。万博省疑似疟疾病例的病例管理不当与医护人员缺乏培训有关，威热省则与ACT缺货有关。
结论
结果揭示了各省之间的重要差异。尽管检测和ACT的可获得性相似，但万博省的检测和治疗率低于威热省。在万博省医疗机构寻求治疗的大多数真正疟疾病例没有得到抗疟药的适当治疗，这突出了在疟疾病例管理中持续培训和监督医护人员的重要性，特别是在疟疾传播减少的地区。
Zotero 插件