Institut de Recherche pour le Développement (IRD), Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle (MIVEGEC), UMR IRD 224-CNRS 5290, University of Montpellier, Montpellier, France.
Centre de Recherche Entomologique de Cotonou, Bénin / Institut de Recherche pour le Développement, UMR 224-CNRS 5290 MIVEGEC, Cotonou, Bénin.
BMC Public Health. 2018 Jan 22;18(1):168. doi: 10.1186/s12889-018-5077-6.
Artemisinin-based combination therapy (ACT), used to treat uncomplicated malaria cases, is one of the main strategies of malaria control and elimination. One of the main objectives of the Benin National Malaria Control Program's (NMCP) strategic plan is to ensure that at least 80% of uncomplicated malaria is treated with ACT within 24 h. Therefore, it was of great interest to measure whether the country case management of fever amongst children under five, adhered to the NMCP's strategic plan and look into the barriers to the use of ACT.
A cross-sectional survey based on a cluster and multi-stage sampling was conducted in two rural health districts in Benin. We recruited 768 and 594 children under five years were included in the northern and in the southern respectively. Data was collected on the general use of ACT and on the correct use of ACT that adheres to the NMCP's strategy, as well as the barriers that prevent the proper management of fever amongst children. To assess the certain predictors of ACT usage, logistic regression was used, while taking into account the cluster random effect.
Among febrile children aged 6 to 59 months, 20.7% in the south and 33.9% in north received ACT. The correct use of ACT, was very low, 5.8% and in southern and 8.6% northern areas. Caregivers who received information on ACT were 3.13 time more likely in the south and 2.98 time more likely in the north to give ACT to their feverish child, PPR = 3.13[1.72-4.15] and PPR = 2.98 [2.72-3.11] respectively. Chloroquine and quinine, other malaria treatments not recommended by NMCP, were still being used in both areas: 12.3 and 3.3% in the south and 11.4 and 3.0% in the north.
In Benin, the use and the correct use of ACT for febrile children remains low. The study also showed that having received information about the use of ACT is positively associated with the use of ACT. This point highlights the fact that efforts may not have been sufficiently integrated with social communication, which should be based on the behavioural determinants of populations.
青蒿素为基础的联合疗法（ACT），用于治疗无并发症的疟疾，是疟疾控制和消除的主要策略之一。贝宁国家疟疾控制规划（NMCP）战略计划的主要目标之一是确保至少 80%的无并发症疟疾在 24 小时内用 ACT 治疗。因此，衡量该国五岁以下儿童发热的病例管理是否符合 NMCP 的战略计划，并探讨使用 ACT 的障碍，这是非常重要的。
在贝宁的两个农村卫生区进行了一项基于聚类和多阶段抽样的横断面调查。我们分别招募了北部和南部各 768 名和 594 名五岁以下儿童。数据收集了一般使用 ACT 和正确使用 ACT，以符合 NMCP 的战略，以及防止儿童发热管理不当的障碍。为了评估 ACT 使用的某些预测因素，我们使用了逻辑回归，同时考虑了聚类随机效应。
在 6 至 59 个月龄发热的儿童中，南部地区有 20.7%，北部地区有 33.9%接受了 ACT。正确使用 ACT 的比例非常低，南部地区为 5.8%，北部地区为 8.6%。在南部地区，接受过关于 ACT 信息的照顾者给发热儿童服用 ACT 的可能性是没有接受过信息的照顾者的 3.13 倍，在北部地区，接受过关于 ACT 信息的照顾者给发热儿童服用 ACT 的可能性是没有接受过信息的照顾者的 2.98 倍，PPR=3.13[1.72-4.15]和 PPR=2.98[2.72-3.11]。氯喹和奎宁，NMCP 不推荐的其他疟疾治疗方法，在这两个地区仍在使用：南部地区为 12.3%和 3.3%，北部地区为 11.4%和 3.0%。
在贝宁，发热儿童使用和正确使用 ACT 的情况仍然很低。研究还表明，接受过关于 ACT 使用的信息与 ACT 的使用呈正相关。这一点突出表明，努力可能没有充分与社会沟通相结合，而社会沟通应该基于人口的行为决定因素。
