评价有监督的抗疟治疗对间日疟疟疾复发的影响。
Evaluation of the effect of supervised anti-malarial treatment on recurrences of Plasmodium vivax malaria.
机构信息
Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
出版信息
Malar J. 2021 Jun 13;20(1):266. doi: 10.1186/s12936-021-03793-0.
BACKGROUND
Relapses in vivax malaria have posed great challenges for malaria control, and they also account for a great proportion of reported cases. Knowing the real effectiveness of a 7-day primaquine (PQ) scheme is crucial in order to evaluate not only the cost-effectiveness of implementing new anti-hypnozoite drugs, but also how health education strategies can guarantee better compliance and be reinforced. This study aimed to evaluate the effect of daily treatment with chloroquine and PQ supervised by health workers versus prescription without supervision.
METHODS
The outcome was the passive detection of new positive thick blood smears up to 180 days, based on the official data records from the National Malaria Control Programme. The recurrences seen in the real life were, therefore, used as a surrogate for true relapses.
RESULTS
Patients under supervised treatment had a lower risk of recurrence up to day 180 when compared to the unsupervised treatment (17.9% vs. 36.1%; p = 0.027).
CONCLUSIONS
The lack of supervision in the non-supervised group (which followed standard of care in the real life) enabled proper comparison, as consent itself would have lead to greater compliance in this group. Future studies should scale such an analysis to different settings in the Brazilian Amazon.
背景
间日疟的复发给疟疾控制带来了巨大挑战，并且它们也占报告病例的很大比例。了解 7 天伯氨喹（PQ）方案的实际效果对于评估新抗休眠期药物的成本效益至关重要，同时也有助于评估健康教育策略如何保证更好的依从性和加强策略。本研究旨在评估由卫生工作者监督的氯喹和 PQ 每日治疗与无监督处方的效果。
方法
根据国家疟疾控制规划的官方数据记录，结果是被动检测 180 天内新的阳性厚血涂片。因此，实际生活中观察到的复发被用作真正复发的替代指标。
结果
与未监督治疗相比，监督治疗组患者在第 180 天之前的复发风险较低（17.9%比 36.1%；p=0.027）。
结论
未监督组缺乏监督（这符合实际生活中的标准治疗）使这种比较成为可能，因为同意本身会导致该组更高的依从性。未来的研究应该在巴西亚马逊的不同环境中扩大这种分析。
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