喀麦隆西部地区5岁以下儿童疟疾预防与治疗的家庭干预：一项随机对照试验方案

Home-Based Intervention for the Prevention and Treatment of Malaria Among Children Younger Than 5 Years in the West Region of Cameroon: Protocol for a Randomized Controlled Trial.

作者信息

Dongmo Kenfack Esther, Tendongfor Nicholas, Nsagha Dickson Shey

机构信息

Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon.

出版信息

JMIR Res Protoc. 2021 Mar 12;10(3):e19633. doi: 10.2196/19633.

DOI:10.2196/19633

PMID:33709938

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7998323/

Abstract

BACKGROUND

Although malaria is preventable and curable, 1 child dies of this disease every 2 minutes in Africa. Home-based management of malaria reduces the progression of severe malaria by more than 50%. Scalable, efficacious, and cost-effective strategies are needed to empower the capacities of home caregivers of children younger than 5 years of age in health education, diagnosis, and treatment of malaria at home.

OBJECTIVE

The main objective of this trial is to assess the impact of the management provided by home caregivers on the prevention, diagnosis, and treatment of malaria in children younger than 5 years as compared to the home-based malaria management component of the integrated community-directed intervention (CDI) strategy of community health workers (CHWs).

METHODS

A randomized controlled trial will be conducted. CHWs have conducted a census of all households where there is at least one child younger than 5 years with their home caregivers. These children and their home caregivers have been randomly placed into the intervention or control groups among the households identified. The trial will allow malaria home-based prevention, diagnosis, and treatment of 350 children younger than 5 years old by home caregivers in the Fombap area (intervention group) where the integrated CDI strategy will not implemented. This group will be compared to the home-based malaria management component of the integrated CDI strategy in which 350 children in the same age group will be followed up by CHWs in the Baneghang area (control group). The primary outcomes will be the prevention, diagnosis, and treatment of malaria in children younger than 5 years of age by home caregivers at home. The secondary outcomes comprise the malaria follow-up indicators produced by home caregivers in the intervention group and those produced by CHWs in the control group. Both descriptive and one-way analysis of variance estimation techniques will be used to compare the mean difference in the 2 strategies.

RESULTS

From September 2019 to October 2019, all home caregivers with children younger than 5 years of age were identified in the intervention and control group by CHWs. Following this, 203 home caregivers with their 350 children younger than 5 years were randomly selected and enrolled in the intervention group, while 225 home caregivers with their 350 children younger than 5 years were enrolled in the control group. In the intervention group, 203 home caregivers were trained in November 2019. This home treatment effectively started in December 2019 and will continue until May 2020.

CONCLUSIONS

Findings from this randomized controlled trial will contribute to resolving the challenges of severe malaria and to limiting the death due to malaria of children younger than 5 years. This will bring benefits to home caregivers who will know how to promptly diagnose and properly treat malaria in their children at home.

TRIAL REGISTRATION

Pan African Clinical Trial Registry (PACTR) 202003487018009; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9788.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19633.

摘要

背景

尽管疟疾是可预防和可治愈的，但在非洲每两分钟就有一名儿童死于这种疾病。在家管理疟疾可使重症疟疾的进展减少50%以上。需要有可扩展、有效且具有成本效益的策略，以增强5岁以下儿童家庭护理人员在家中进行疟疾健康教育、诊断和治疗的能力。

目的

本试验的主要目的是评估与社区卫生工作者（CHW）综合社区定向干预（CDI）策略中的家庭疟疾管理部分相比，家庭护理人员提供的管理对5岁以下儿童疟疾预防、诊断和治疗的影响。

方法

将进行一项随机对照试验。CHW对所有至少有一名5岁以下儿童及其家庭护理人员的家庭进行了普查。这些儿童及其家庭护理人员被随机分配到已识别家庭中的干预组或对照组。该试验将允许Fombap地区（干预组）的家庭护理人员对350名5岁以下儿童进行家庭疟疾预防、诊断和治疗，该地区不会实施综合CDI策略。将该组与综合CDI策略中的家庭疟疾管理部分进行比较，在Baneghang地区（对照组），CHW将对350名同年龄组儿童进行随访。主要结局将是家庭护理人员在家中对5岁以下儿童疟疾的预防、诊断和治疗。次要结局包括干预组家庭护理人员产生的疟疾随访指标和对照组CHW产生的指标。将使用描述性和单因素方差分析估计技术来比较两种策略的平均差异。

结果

2019年9月至2019年10月，CHW在干预组和对照组中识别出了所有有5岁以下儿童的家庭护理人员。此后，随机选择了203名家庭护理人员及其350名5岁以下儿童纳入干预组，225名家庭护理人员及其350名5岁以下儿童纳入对照组。在干预组中，203名家庭护理人员于2019年11月接受了培训。这种家庭治疗于2019年12月有效开始，并将持续到2020年5月。