Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA.
Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Malar J. 2021 Jan 21;20(1):56. doi: 10.1186/s12936-021-03590-9.
Access and adherence to artemisinin-based combination therapy (ACT) are key challenges to effective malaria treatment. A secondary analysis of the Sierra Leone malaria Knowledge, Attitudes, and Practices (mKAP) survey was conducted to investigate access and adherence to ACT for the treatment of fever in children under-five.
The mKAP was a nationally representative, two-stage cluster-sample survey, conducted in 2012. Thirty primary sampling units per district were randomly selected using probability proportionate to size, based on national census estimates; 14 households were subsequently randomly selected and enrolled per sampling unit. The analysis was restricted to children under-five with fever in the past two weeks. Factors associated with access and adherence were assessed using multivariate logistic regression.
Of 5169 enrolled households, 1456 reported at least one child under-five with fever in the past two weeks. Of the 1641 children from these households, 982 (59.8%) received any treatment for fever and were analysed for access to ACT; 469 (47.6%) received ACT and 466 were analysed for treatment adherence. Only 222 (47.4%) febrile children received ACT and completed 3-day treatment. In an adjusted analysis, factors associated with ACT access included knowledge of ACT (odds ratio [OR] 2.78, 95% CI 2.02-3.80; p < 0.001), knowledge of insecticide-treated nets (ITNs) (OR 1.84, 95% CI 1.29-2.63; p = 0.001), source of care (public health facility vs. other; OR 1.86, 95% CI 1.27-2.72, p = 0.001), geographic region (East vs. West; OR 2.30, 95% CI 1.20-4.44; p = 0.025), and age (24-59 vs. 0-23 months; OR 1.45, 95% CI 1.07-1.96; p = 0.016). The only factor associated with ACT adherence was time to treatment; children treated within 24 h were less likely to adhere (OR 0.55, 95% CI 0.34-0.89; p = 0.015).
In 2012, access and adherence to ACT remained low in Sierra Leone. Knowledge of ACT and ITNs, and seeking care in the public sector, were most strongly associated with ACT access. National surveys provide important information on anti-malarial access and could be expanded to measure treatment adherence.
青蒿素类复方疗法（ACT）的可及性和可接受性是有效疟疾治疗的关键挑战。对塞拉利昂疟疾知识、态度和实践（mKAP）调查的二次分析旨在调查五岁以下儿童发热时使用 ACT 治疗的可及性和可接受性。
mKAP 是一项全国代表性的两阶段聚类抽样调查，于 2012 年进行。根据全国人口普查估计，每个区采用按大小比例概率抽样选择 30 个初级抽样单位；随后每个抽样单位随机选择并登记了 14 户家庭。分析仅限于过去两周内有发热的五岁以下儿童。使用多变量逻辑回归评估与可及性和可接受性相关的因素。
在 5169 户登记的家庭中，有 1456 户报告过去两周内至少有一名五岁以下发热儿童。在这些家庭的 1641 名儿童中，有 982 名（59.8%）因发热接受了任何治疗，并对 ACT 的可及性进行了分析；469 名（47.6%）接受了 ACT，对 466 名进行了治疗依从性分析。只有 222 名（47.4%）发热儿童接受了 ACT 并完成了 3 天的治疗。在调整分析中，与 ACT 可及性相关的因素包括对 ACT 的了解（比值比[OR]2.78，95%置信区间[CI]2.02-3.80；p<0.001）、对驱虫蚊帐（ITN）的了解（OR 1.84，95%CI 1.29-2.63；p=0.001）、护理来源（公共卫生机构与其他；OR 1.86，95%CI 1.27-2.72，p=0.001）、地理区域（东部与西部；OR 2.30，95%CI 1.20-4.44；p=0.025）和年龄（24-59 个月与 0-23 个月；OR 1.45，95%CI 1.07-1.96；p=0.016）。与 ACT 依从性相关的唯一因素是治疗时间；在 24 小时内接受治疗的儿童不太可能依从（OR 0.55，95%CI 0.34-0.89；p=0.015）。
2012 年，塞拉利昂 ACT 的可及性和依从性仍然较低。对 ACT 和 ITN 的了解以及在公共部门寻求护理与 ACT 的可及性关系最密切。国家调查提供了有关抗疟药可及性的重要信息，并且可以扩大调查范围以衡量治疗依从性。
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