National Malaria Control Programme, Conakry, Guinea.
Department of Public Health, University of Conakry, Conakry, Guinea.
Malar J. 2019 Jan 25;18(1):23. doi: 10.1186/s12936-019-2664-7.
The World Health Organization recommends the use of artemisinin-based combination therapy (ACT) to treat uncomplicated malaria for the control of malaria across the world. There are several types of ACT used across malaria-endemic countries, yet there is little information about preferences and adherence practices regarding different types of ACT. The objective of this study was to evaluate levels of adherence to two types of ACT, artemether-lumefantrine (AL) and artesunate + amodiaquine (ASAQ), for the treatment of uncomplicated malaria among prescribers and patients in Guinea in 2016.
The study included a review of records of malaria patients and three health-facility, cross-sectional surveys. Patients diagnosed with uncomplicated malaria and prescribed ACT (n = 1830) were recruited and visited in their home after receiving the medication and administered a questionnaire regarding ACT adherence. Prescribers (n = 115) and drug dispensers (n = 43) were recruited at the same public health facilities and administered questionnaires regarding prescribing practices and opinions regarding the national treatment policies and protocols.
According to the registry review, 35.8% of all-cause consultations were recorded as malaria. Of these, 26.6% were diagnosed clinically without documentation of laboratory confirmation. The diagnosis of uncomplicated malaria represented 64.1% of malaria cases among children under 5 years and 74.9% of those 5 years of age and older. An ACT was prescribed for 83.5% of cases of uncomplicated malaria. Among participants in the study, ACT adherence was 95.4% (95% CI 94.4, 96.3). Overall, about one in four patients (23.4%; 95% CI 21.5, 25.3) reported experiencing adverse events. While patients prescribed ASAQ were significantly more likely to report experiencing adverse effects than patients on AL (p < 0.001), given the overall high adherence, there was no evidence of a statistically significant difference in adherence between AL and ASAQ. Patients 5 years or older who reported experiencing adverse events were more likely to be non-adherent.
Although there were more reported adverse events associated with ASAQ when compared with AL, both prescribers and patients were found to be mostly adherent to ACT for the treatment of malaria, regardless of ACT type.
世界卫生组织建议使用青蒿素类复方疗法（ACT）治疗无并发症疟疾，以控制全球疟疾。在疟疾流行国家使用了几种类型的 ACT，但关于不同类型的 ACT 的偏好和依从实践的信息很少。本研究的目的是评估 2016 年在几内亚的医生和患者对两种类型的 ACT（青蒿琥酯-咯萘啶（AL）和青蒿琥酯+阿莫地喹（ASAQ））治疗无并发症疟疾的依从水平。
该研究包括对疟疾患者记录的审查和三项卫生机构的横断面调查。招募了诊断为无并发症疟疾并开了 ACT（n=1830）的患者，并在他们服药后在家中对其进行了随访，并对他们进行了有关 ACT 依从性的问卷调查。在同一公共卫生机构招募了医生（n=115）和药剂师（n=43），并对他们进行了关于处方实践以及对国家治疗政策和方案的看法的问卷调查。
根据记录审查，所有原因就诊中有 35.8%被记录为疟疾。其中，26.6%未经实验室确认即临床诊断。5 岁以下儿童中 64.1%的疟疾病例和 5 岁以上儿童中 74.9%的疟疾病例被诊断为无并发症疟疾。83.5%的无并发症疟疾病例开了 ACT。在研究参与者中，ACT 依从率为 95.4%（95%CI 94.4，96.3）。总体而言，大约四分之一的患者（23.4%；95%CI 21.5，25.3）报告出现了不良反应。虽然服用 ASAQ 的患者报告出现不良反应的可能性明显高于服用 AL 的患者（p<0.001），但由于总体依从率较高，AL 和 ASAQ 之间的依从率没有统计学意义上的显著差异。报告出现不良反应的 5 岁及以上患者更有可能不依从。
尽管与 AL 相比，ASAQ 相关的不良反应报告更多，但无论 ACT 类型如何，医生和患者对 ACT 治疗疟疾的依从性都很高。
