Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.
Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain.
PLoS One. 2019 Aug 2;14(8):e0220789. doi: 10.1371/journal.pone.0220789. eCollection 2019.
In Equatorial Guinea, malaria continues to be one of the main causes of morbidity and mortality among children. The National Therapeutic Guide established artesunate-amodiaquine (ASAQ) as first-line treatment for uncomplicated malaria, but compliance with this treatment is low. The aim of this study was to assess, for the first time, the performance of public healthcare workers in the diagnosis and treatment of uncomplicated malaria, their compliance with first-line Malaria National Therapeutic Guide and the associated factors.
A cross-sectional survey was conducted at the nine public health facilities in the Bata District of Equatorial Guinea to assess the management of uncomplicated malaria in children < 15 years of age. Bivariate and multivariate statistical analyses were used to determine the recommended treatment compliance and related factors.
A total of 227 children with uncomplicated malaria were recorded from 9 public health facilities. Most of the treatments prescribed (83.3%) did not follow the first-line treatment recommended for uncomplicated malaria. The diagnosis was established with parasite confirmation in 182 cases (80.2%). After adjustment for other variables, children under 2 months of age, the use of parasite confirmation to the diagnosis of malaria and being familiar with the national therapeutic guide were significantly associated with the prescription of the first-line recommended treatment. Cases attended at the hospital or in a health facility with ASAQ in the pharmacy at the time of the study were also more likely to be prescribed with the recommended treatment, but with non-significant association after adjustment for other variables.
This study identified the factors associated with the low compliance with the first-line treatment by the public healthcare facilities of Bata District of Equatorial Guinea. It seems necessary to improve case management of children with uncomplicated malaria; to reinforce the use of Malaria National Therapeutic Guide and to inform about the danger of using artemisinin monotherapy. Furthermore, it is crucial to provide recommended first-line treatment to the pharmacies of all public health facilities to ensure access to this treatment.
在赤道几内亚，疟疾仍然是儿童发病率和死亡率的主要原因之一。国家治疗指南将青蒿琥酯-阿莫地喹（ASAQ）定为治疗无并发症疟疾的一线药物，但这种治疗方法的依从性很低。本研究的目的是首次评估公共卫生工作者在诊断和治疗无并发症疟疾方面的表现，评估他们对国家一线疟疾治疗指南的遵守情况及其相关因素。
在赤道几内亚巴塔地区的 9 个公共卫生机构进行了一项横断面调查，以评估儿童<15 岁的无并发症疟疾管理情况。采用单变量和多变量统计分析来确定推荐的治疗依从性及其相关因素。
从 9 个公共卫生机构共记录了 227 例无并发症疟疾儿童。大多数处方的治疗方法（83.3%）没有遵循推荐的无并发症疟疾一线治疗方法。182 例（80.2%）通过寄生虫确认来诊断疟疾。在调整其他变量后，2 个月以下的儿童、寄生虫确认用于疟疾诊断以及熟悉国家治疗指南与一线推荐治疗的处方显著相关。在研究时医院或卫生机构药房有 ASAQ 的病例也更有可能被开具推荐的治疗方法，但在调整其他变量后相关性不显著。
本研究确定了赤道几内亚巴塔地区公共卫生机构一线治疗依从性低的相关因素。似乎有必要改善儿童无并发症疟疾的病例管理；加强国家治疗指南的使用，并告知使用青蒿素单一疗法的危险。此外，向所有公共卫生机构的药房提供推荐的一线治疗药物，以确保获得这种治疗药物至关重要。
