青蒿琥酯-咯萘啶治疗在埃塞俄比亚提格雷地区阿塞德齐姆布拉区公立卫生机构就诊的无并发症恶性疟原虫疟疾患者的依从性：一项横断面研究。

Artemether-lumefantrin treatment adherence among uncomplicated plasmodium falciparum malaria patients, visiting public health facilities in AsgedeTsimbla district, Tigray, Ethiopia: a cross-sectional study.

机构信息

Tigray Regional Health Bureau, Mekelle, Tigray, Ethiopia.

College of Health Sciences, School of Public Health, Department of Epidemiology, Mekelle University, Mekelle, Tigray, Ethiopia.

出版信息

Antimicrob Resist Infect Control. 2020 Nov 10;9(1):184. doi: 10.1186/s13756-020-00846-y.

DOI:10.1186/s13756-020-00846-y

PMID:33168093

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7653737/

Abstract

BACKGROUND

Ethiopia has set a goal to eliminate malaria by 2030; Artemether-lumefantrine (AL) is put as one of the cornerstone strategies for uncomplicated plasmodium falciparum malaria treatment. However, only focusing on prescribing of the treatment without assessing patients' adherence could lead to the resistance of the drug. In Ethiopia, there is limited evidence about patients' adherence to AL and its influencing factors. Therefore, this study aimed at addressing this information gap.

METHODS

A health facility based cross-sectional study was employed. Participants were selected using simple random sampling technique from registration books of the public health facilities in AsgedeTsimbla. Data were collected from March 24th to April 30th, 2018. We interviewed participants using a pre-tested structured questionnaire, and the blister pack was also inspected at their homes on day 4. Data were entered into Epi-Info and analyzed using SPSS 21. Odds ratios with 95% Confidence Intervals were estimated and the level of significance was declared at p-value ≤ 0.05.

RESULTS

A total of 384 study participants were interviewed with a response rate of 95.5%. The overall AL adherence was 53.6% (95% CI 48.4-58.3%). Children aged < 5 years [AOR: 0.4, 95% CI (0.2-0.8)], and being treated in health post [AOR: 0.3, 95% CI (0.1-0.5)] were more likely to show AL adherence whereas illiteracy [AOR: 9.4, 95% CI (4.2-21.3)], didn't know the consequence of discontinued AL [AOR: 4.0, 95% CI (2.1-7.6)], had concomitant drugs [AOR: 2.5, 95% CI (1.4-4.5)], and stopped/saved drug when improved before tablet got finished [AOR: 3.2, 95% CI (1.7-5.9)] were factors less likely to be associated with AL adherence.

CONCLUSION

AL adherence was low. Children aged < 5 years, and being treated in health post were determinants of AL adherence whereas illiteracy, didn't know the consequence of discontinued the drug, had concomitant drugs, and stopped/saved drug when improved before tablet got finished were factors that hindered the AL adherence. Stakeholders should emphasize designing appropriate strategies including educational interventions to increase the AL adherence and prevent drug resistance. Further research should be conducted to evaluate AL resistance.

摘要

背景

埃塞俄比亚设定了到 2030 年消除疟疾的目标；青蒿琥酯-咯萘啶（AL）被作为治疗无并发症恶性疟原虫疟疾的基石策略之一。然而，仅仅关注处方而不评估患者的依从性可能会导致药物产生耐药性。在埃塞俄比亚，关于患者对 AL 的依从性及其影响因素的证据有限。因此，本研究旨在填补这一信息空白。

方法

采用基于卫生机构的横断面研究。参与者采用简单随机抽样技术从公共卫生机构的登记册中选取。数据于 2018 年 3 月 24 日至 4 月 30 日收集。我们使用经过预测试的结构化问卷对参与者进行访谈，并在第 4 天在他们的家中检查泡罩包装。数据输入 Epi-Info 并使用 SPSS 21 进行分析。使用 95%置信区间的比值比进行估计，并在 p 值≤0.05 时宣布显著性水平。

结果

共对 384 名研究参与者进行了访谈，应答率为 95.5%。总体上，AL 依从性为 53.6%（95%CI 48.4-58.3%）。年龄<5 岁的儿童[AOR：0.4，95%CI（0.2-0.8）]和在卫生所接受治疗的儿童[AOR：0.3，95%CI（0.1-0.5）]更有可能表现出 AL 依从性，而文盲[AOR：9.4，95%CI（4.2-21.3）]、不知道停止 AL 治疗的后果[AOR：4.0，95%CI（2.1-7.6）]、同时服用其他药物[AOR：2.5，95%CI（1.4-4.5）]以及在药丸用完之前病情改善时停止/节省药物[AOR：3.2，95%CI（1.7-5.9）]不太可能与 AL 依从性相关。

结论

AL 依从性较低。年龄<5 岁的儿童和在卫生所接受治疗是 AL 依从性的决定因素，而文盲、不知道停止药物的后果、同时服用其他药物以及在药丸用完之前病情改善时停止/节省药物是阻碍 AL 依从性的因素。利益相关者应强调制定适当的策略，包括教育干预措施，以提高 AL 的依从性并预防耐药性。应进一步开展研究评估 AL 耐药性。