疟疾快速诊断检测扩大规模对发热疾病常规临床诊断程序的影响：巴布亚新几内亚的一系列重复横断面研究。

The impact of the scale-up of malaria rapid diagnostic tests on the routine clinical diagnosis procedures for febrile illness: a series of repeated cross-sectional studies in Papua New Guinea.

机构信息

Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.

Liverpool School of Tropical Medicine, Liverpool, UK.

出版信息

Malar J. 2018 May 16;17(1):202. doi: 10.1186/s12936-018-2351-0.

DOI:10.1186/s12936-018-2351-0

PMID:29769128

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5956836/

Abstract

BACKGROUND

This paper examines the impact of the scale-up of malaria rapid diagnostic tests (RDT) on routine clinical diagnosis procedures for febrile illness in primary healthcare settings in Papua New Guinea.

METHODS

Repeat, cross-sectional surveys in randomly selected primary healthcare services were conducted. Surveys included passive observation of consecutive febrile case management cases and were completed immediately prior to RDT scale-up (2011) and at 12- (2012) and 60-months (2016) post scale-up. The frequency with which specified diagnostic questions and procedures were observed to occur, with corresponding 95% CIs, was calculated for febrile patients prescribed anti-malarials pre- and post-RDT scale-up and between febrile patients who tested either negative or positive for malaria infection by RDT (post scale-up only).

RESULTS

A total of 1809 observations from 120 health facilities were completed across the three survey periods of which 915 (51%) were prescribed an anti-malarial. The mean number of diagnostic questions and procedures asked or performed, leading to anti-malarial prescription, remained consistent pre- and post-RDT scale-up (range 7.4-7.7). However, alterations in diagnostic content were evident with the RDT replacing body temperature as the primary diagnostic procedure performed (observed in 5.3 and 84.4% of cases, respectively, in 2011 vs. 77.9 and 58.2% of cases in 2016). Verbal questioning, especially experience of fever, cough and duration of symptoms, remained the most common feature of a diagnostic examination leading to anti-malarial prescription irrespective of RDT use (observed in 96.1, 86.8 and 84.8% of cases, respectively, in 2011 vs. 97.5, 76.6 and 85.7% of cases in 2016). Diagnostic content did not vary substantially by RDT result.

CONCLUSIONS

Rapid diagnostic tests scale-up has led to a reduction in body temperature measurement. Investigations are very limited when malaria infection is ruled out as a cause of febrile illness by RDT.

摘要

背景

本文研究了在巴布亚新几内亚基层医疗保健环境中，疟疾快速诊断检测（RDT）的推广对发热病例常规临床诊断程序的影响。

方法

在随机选择的基层医疗服务中进行重复的横断面调查。调查包括对连续发热病例管理病例进行被动观察，并在 RDT 推广之前（2011 年）和推广后 12 个月（2012 年）和 60 个月（2016 年）立即完成。计算了在 RDT 推广之前和之后，为发热患者开具抗疟药物的情况下，观察到指定诊断问题和程序的频率，并计算了相应的 95%置信区间，以及 RDT 检测为疟疾感染阴性或阳性的发热患者之间的频率（仅在推广后）。

结果

在三个调查期间共完成了 1809 次观察，其中 120 个卫生设施中有 915 次（51%）被开具了抗疟药物。在 RDT 推广之前和之后，询问或执行的诊断问题和程序的平均数量保持一致（范围为 7.4-7.7）。然而，随着 RDT 取代体温成为主要的诊断程序，诊断内容发生了变化（2011 年分别观察到 5.3%和 84.4%的病例，而 2016 年分别观察到 77.9%和 58.2%的病例）。口头询问，尤其是发热、咳嗽和症状持续时间的经历，仍然是导致开具抗疟药物的最常见的诊断检查特征，无论是否使用 RDT（2011 年分别观察到 96.1%、86.8%和 84.8%的病例，而 2016 年分别观察到 97.5%、76.6%和 85.7%的病例）。诊断内容在 RDT 结果方面没有显著差异。