对马拉维农村流动诊所接待的成年非疟疾发热患者进行的为期14天的随访。

A 14-day follow-up of adult non-malarial fever patients seen by mobile clinics in rural Malawi.

作者信息

Baltzell Kimberly A, Kortz Teresa Bleakly, Blair Alden, Scarr Ellen, Mguntha Andrew M, Bandawe Gama, Schell Ellen, Rankin Sally H

机构信息

Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.

Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA.

出版信息

Malawi Med J. 2020 Mar;32(1):31-36. doi: 10.4314/mmj.v32i1.7.

DOI:10.4314/mmj.v32i1.7

PMID:32733657

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7366163/

Abstract

BACKGROUND

While health providers consistently use malaria rapid diagnostic tests to rule out malaria, they often lack tools to guide treatment for those febrile patients who test negative. Without the tools to provide an alternative diagnosis, providers may prescribe unnecessary antibiotics or miss a more serious condition, potentially contributing to antibiotic resistance and/or poor patient outcomes.

METHODS

This study ascertained which diagnoses and treatments might be associated with poor outcomes in adults who test negative for malaria. Adult patients for rapid diagnostic test of malaria seen in mobile health clinics in Mulanje and Phalombe districts were followed for 14 days. Participants were interviewed on sociodemographic characteristics, health-seeking behaviour, diagnosis, treatment and access to care. Mobile clinic medical charts were reviewed. Two weeks (±2 days) following clinic visit, follow-up interviews were conducted to assess whether symptoms had resolved.

RESULTS

Initially, 115 adult patients were enrolled and 1 (0.88%) was lost to follow-up. Of the 114 adult patients remaining in the study, 55 (48%) were seen during the dry season and 59 (52%) during the wet season. Symptoms resolved in 90 (80%) patients at the 14-day follow-up visit (n=90) with the rest (n=24) reporting no change in symptoms. None of the patients in the study died or were referred for further care. Almost all patients received some type of medication during their clinic visit (98.2%). Antibiotics were given to 38.6% of patients, and virtually all patients received pain or fever relief (96.5%). However, no anti-malarials were prescribed.

CONCLUSIONS

Mobile clinics provide important health care where access to care is limited. Although rapid tests have guided appropriate treatment, challenges remain when a patient's presenting complaint is less well defined. In rural areas of southern Malawi, simple diagnostics are needed to guide treatment decisions.

摘要

背景

虽然医疗服务提供者一直使用疟疾快速诊断测试来排除疟疾，但他们往往缺乏为检测呈阴性的发热患者提供治疗指导的工具。由于缺乏提供替代诊断的工具，医疗服务提供者可能会开出不必要的抗生素，或者漏诊更严重的疾病，这可能会导致抗生素耐药性和/或患者预后不良。

方法

本研究确定了哪些诊断和治疗可能与疟疾检测呈阴性的成年人预后不良有关。对在穆兰杰和法隆贝地区的移动健康诊所接受疟疾快速诊断测试的成年患者进行了为期14天的随访。就社会人口学特征、就医行为、诊断、治疗和获得医疗服务的情况对参与者进行了访谈。审查了移动诊所的病历。在诊所就诊两周（±2天）后，进行了随访访谈，以评估症状是否已缓解。

结果

最初，招募了115名成年患者，1名（0.88%）失访。在研究中剩余的114名成年患者中，55名（48%）在旱季就诊，59名（52%）在雨季就诊。在14天的随访就诊时，90名（80%）患者的症状得到缓解（n = 90），其余患者（n = 24）报告症状无变化。研究中没有患者死亡或被转诊接受进一步治疗。几乎所有患者在诊所就诊期间都接受了某种类型的药物治疗（98.2%）。38.6%的患者接受了抗生素治疗，几乎所有患者都接受了止痛或退热治疗（96.5%）。然而，没有开出抗疟疾药物。