乌干达穆拉戈医院急诊科收治的疟疾患儿的院前用药情况：一项描述性研究。

Use of pre-hospital medication in children presenting with malaria to the emergency unit of Mulago Hospital, Uganda: A descriptive study.

作者信息

Tumukunde Victor S, Kiboneka Elizabeth, John Chandy C, Opoka Robert O, Idro Richard

机构信息

Department of Paediatrics and Child health, Mulago National Referral Hospital and Makerere University, Kampala, Uganda.

Division of Global Paediatrics, University of Minnesota, USA.

出版信息

Malariaworld J. 2017 Jul;8. Epub 2017 Jul 28.

PMID:29623255

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5881584/

Abstract

BACKGROUND

Initiation of specific antimalarial treatment within 24 hrs of fever onset at home and before presentation to the hospital is one of the strategies to reduce mortality from malaria in sub-Saharan Africa. In order to determine whether this strategy is being implemented we describe the use and factors associated with the use of pre-hospital medications among children admitted with malaria in one of the tertiary hospitals in Uganda.

MATERIALS AND METHODS

Use of pre-hospital medications was assessed in 205 children aged 6-59 months and diagnosed with malaria at admission in Mulago hospital. Data were obtained on the type, source, and dose adequacy of medicines used before presentation to the hospital as well as the socio-demographical characteristics of the children. The proportion of children using pre-hospital medication was determined and logistic regression analysis used to determine factors associated with use of pre-hospital medication.

RESULTS

Overall, 147/205 (72%) of the children were given some medication for their illness before presentation to the hospital. The common pre-hospital medicines used were paracetamol (107/147, 72.8 %) and antimalarial medicines (91/147, 61.9 %). Antibiotics were used in only 12 (8.2 %) of the cases. The majority (62/91, 68%) of the cases got medicines from a health facility but only 41/91 (45%) received an adequate dose. Having fever for more than three days was significantly associated with use of pre-hospital medicines (OR = 2.2; 95% CI 1.12-4.35; p = 0.02).

CONCLUSIONS

The pre-hospital use of medicines is common amongst children presenting with malaria to this tertiary Ugandan hospital. The practice is, however, associated with use of inadequate doses of antimalarials and delay in presentation to the hospital. More effort is therefore needed to educate communities on the importance of proper home management of malaria.

摘要

背景

在撒哈拉以南非洲地区，在发热开始后的24小时内且在前往医院就诊之前在家中开始进行特定的抗疟治疗，是降低疟疾死亡率的策略之一。为了确定该策略是否得到实施，我们描述了乌干达一家三级医院中因疟疾入院的儿童使用院前药物的情况及相关因素。

材料与方法

对穆拉戈医院收治的205名年龄在6至59个月且入院时被诊断为疟疾的儿童进行了院前药物使用情况评估。获取了患儿在前往医院就诊之前所使用药物的类型、来源和剂量充足性以及儿童的社会人口学特征等数据。确定了使用院前药物的儿童比例，并采用逻辑回归分析来确定与使用院前药物相关的因素。

结果

总体而言，147/205（72%）的儿童在前往医院就诊之前针对其疾病服用了某种药物。常用的院前药物是对乙酰氨基酚（107/147，72.8%）和抗疟药物（91/147，61.9%）。仅12例（8.2%）使用了抗生素。大多数病例（62/91，68%）从医疗机构获得药物，但只有41/91（45%）接受了足量药物。发热超过三天与使用院前药物显著相关（比值比 = 2.2；95%置信区间1.12 - 4.35；p = 0.02）。