Centre for International Health and Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
College of Medicine, University of Malawi, Blantyre, Malawi.
BMC Health Serv Res. 2018 Jul 11;18(1):544. doi: 10.1186/s12913-018-3327-z.
In malaria endemic countries of sub-Saharan Africa, many children develop severe anaemia due to previous and current malaria infections. After blood transfusions and antimalarial treatment at the hospital they are usually discharged without any follow-up. In the post-discharge period, these children may contract new malaria infections and develop rebound severe anaemia. A randomised placebo-controlled trial in Malawi showed 31% reduction in malaria- and anaemia-related deaths or hospital readmissions among children under 5 years of age given antimalarial drugs for 3 months post-discharge. Thus, post-discharge malaria chemoprevention (PMC) may provide substantial protection against malaria and anaemia in young children living in areas of high malaria transmission. A delivery implementation trial is currently being conducted in Malawi to determine the optimal strategy for PMC delivery. In the trial, PMC is delivered through community- or facility-based methods with or without the use of reminders via phone text message or visit from a Health Surveillance Assistant. This paper describes the acceptance of PMC among caregivers.
From October to December 2016, 30 in-depth interviews and 5 focus group discussions were conducted with caregivers of children who recently completed the last treatment course in the trial. Views on the feasibility of various delivery methods and reminder strategies were collected. The interviews were transcribed verbatim, translated to English, and coded using the software programme NVivo.
Community-based delivery was perceived as more favourable than facility-based delivery due to easy home access to drugs and fewer financial concerns. Many caregivers reported lack of visits from Health Surveillance Assistants and preferred text message reminders sent directly to their phones rather than waiting on these visits. Positive attitudes towards active use of health cards for remembering treatment dates were especially evident. Additionally, caregivers shared positive experiences from participation in the programme and described dihydroartemisinin-piperaquine as a safe and effective antimalarial drug that improved the health and well-being of their children.
Post-discharge malaria chemoprevention given to children under the age of 5 previously treated for severe anaemia is highly accepted among caregivers. Caregivers prefer community-based delivery with use of health cards as their primary tool of reference.
NCT02721420 (February 13, 2016).
在撒哈拉以南非洲的疟疾流行国家，许多儿童因以前和现在的疟疾感染而出现严重贫血。在医院接受输血和抗疟治疗后，他们通常在没有任何后续治疗的情况下出院。在出院后期间，这些儿童可能会再次感染疟疾并出现严重贫血反弹。马拉维的一项随机安慰剂对照试验表明，在出院后 3 个月内给予抗疟药物的 5 岁以下儿童中，疟疾和贫血相关死亡或住院再次入院的比例降低了 31%。因此，出院后疟疾化学预防（PMC）可能会为生活在疟疾高度传播地区的幼儿提供针对疟疾和贫血的实质性保护。目前正在马拉维进行一项交付实施试验，以确定 PMC 交付的最佳策略。在试验中，PMC 通过社区或医疗机构提供，无论是否使用电话短信或健康监测助手访问的提醒方式。本文描述了照顾者对 PMC 的接受程度。
2016 年 10 月至 12 月，对最近完成试验最后一疗程的儿童的照顾者进行了 30 次深入访谈和 5 次焦点小组讨论。收集了对各种交付方法和提醒策略的可行性的看法。访谈内容逐字记录，翻译成英文，然后使用 NVivo 软件进行编码。
社区为基础的交付被认为比机构为基础的交付更有利，因为药物更容易在家中获得，而且财务问题也较少。许多照顾者报告说没有健康监测助手的访问，他们更希望直接将短信提醒发送到自己的手机上，而不是等待这些访问。积极使用健康卡来记住治疗日期的态度尤其明显。此外，照顾者分享了参与该计划的积极经验，并描述了二氢青蒿素-哌喹是一种安全有效的抗疟药物，改善了他们孩子的健康和福祉。
以前接受过严重贫血治疗的 5 岁以下儿童接受的出院后疟疾化学预防措施在照顾者中得到了高度认可。照顾者更喜欢以社区为基础的交付方式，并将使用健康卡作为主要参考工具。
NCT02721420（2016 年 2 月 13 日）。
