Ladner Joël, Davis Ben, Audureau Etienne, Saba Joseph
Rouen University Hospital, Epidemiology and Health Promotion Department, Hôpital Charles Nicolle, 1 Rue de Germont, 76 031, Rouen Cedex, France.
Axios International, Paris, France.
Malar J. 2017 Aug 29;16(1):353. doi: 10.1186/s12936-017-1997-3.
Artemisinin-based combination therapy (ACT) is recommended as the first-line anti-malarial treatment strategy in sub-Saharan African countries. WHO policy recommends parasitological confirmation by microscopy or rapid diagnostic test (RDT) in all cases of suspected malaria prior to treatment. Gaps remain in understanding the factors that influence patient treatment-seeking behaviour and anti-malarial drug purchase decisions in the private sector. The objective of this study was to identify patient treatment-seeking behaviour in Ghana, Kenya, Nigeria, Tanzania, and Uganda.
Face-to-face patient interviews were conducted at a total of 208 randomly selected retail outlets in five countries. At each outlet, exit interviews were conducted with five patients who indicated they had come seeking anti-malarial treatment. The questionnaire was anonymous and standardized in the five countries and collected data on different factors, including socio-demographic characteristics, history of illness, diagnostic practices (i.e. microscopy or RDT), prescription practices and treatment purchase. The price paid for the treatment was also collected from the outlet vendor.
A total of 994 patients were included from the five countries. Location of malaria diagnosis was significantly different in the five countries. A total of 484 blood diagnostic tests were performed, (72.3% with microscopy and 27.7% with RDT). ACTs were purchased by 72.5% of patients who had undergone blood testing and 86.5% of patients without a blood test, regardless of whether the test result was positive or negative (p < 10). A total of 531 patients (53.4%) had an anti-malarial drug prescription, of which 82.9% were prescriptions for an ACT. There were significant differences in prescriptions by country. A total of 923 patients (92.9%) purchased anti-malarial drugs in an outlet, including 79.1% of patients purchasing an ACT drug: 98.0% in Ghana, 90.5% in Kenya, 80.4% in Nigeria, 69.2% in Tanzania, and 57.7% in Uganda (p < 10). Having a drug prescription was not a significant predictive factor associated with an ACT drug purchase (except in Kenya). The number of ACT drugs purchased with a prescription was greater than the number purchased without a prescription in Kenya, Nigeria and Tanzania.
This study highlights differences in drug prescription and purchase patterns in five sub-Saharan African countries. The private sector is playing an increasingly important role in fever case management in sub-Saharan Africa. Understanding the characteristics of private retail outlets and the role they play in providing anti-malaria drugs may support the design of effective malaria interventions.
以青蒿素为基础的联合疗法（ACT）被推荐为撒哈拉以南非洲国家的一线抗疟治疗策略。世界卫生组织的政策建议，在所有疑似疟疾病例治疗前，通过显微镜检查或快速诊断检测（RDT）进行寄生虫学确诊。在理解影响患者寻求治疗行为以及私营部门抗疟药物购买决策的因素方面，仍存在差距。本研究的目的是确定加纳、肯尼亚、尼日利亚、坦桑尼亚和乌干达患者的治疗寻求行为。
在五个国家共208个随机选择的零售网点进行了面对面的患者访谈。在每个网点，对五名表示前来寻求抗疟治疗的患者进行了出院访谈。问卷在五个国家是匿名且标准化的，收集了不同因素的数据，包括社会人口统计学特征、病史、诊断方法（即显微镜检查或RDT）、处方做法和治疗购买情况。还从网点供应商处收集了治疗所支付的价格。
五个国家共纳入了994名患者。五个国家疟疾诊断的地点存在显著差异。共进行了484次血液诊断检测，（72.3%通过显微镜检查，27.7%通过RDT）。无论检测结果是阳性还是阴性，接受血液检测的患者中有72.5%购买了ACT，未进行血液检测的患者中有86.5%购买了ACT（p < 0.10）。共有531名患者（53.4%）有抗疟药物处方，其中82.9%是ACT的处方。不同国家的处方存在显著差异。共有923名患者（92.9%）在网点购买了抗疟药物，其中79.1%的患者购买了ACT药物：加纳为98.0%，肯尼亚为90.5%，尼日利亚为80.4%，坦桑尼亚为69.2%，乌干达为57.7%（p < 0.10）。有药物处方并非与购买ACT药物相关的显著预测因素（肯尼亚除外）。在肯尼亚、尼日利亚和坦桑尼亚，凭处方购买的ACT药物数量多于无处方购买的数量。
本研究突出了撒哈拉以南非洲五个国家在药物处方和购买模式上的差异。私营部门在撒哈拉以南非洲发热病例管理中发挥着越来越重要的作用。了解私营零售网点的特征及其在提供抗疟药物方面所起的作用，可能有助于设计有效的疟疾干预措施。
