Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
Malar J. 2022 Jun 27;21(1):202. doi: 10.1186/s12936-022-04225-3.
In Burkina Faso, malaria remains the first cause of medical consultation and hospitalization in health centres. First-line case management of malaria in the country's health facilities is based on the use of artemisinin-based combination therapy (ACT). To optimize the use of these anti-malarial drugs in the perspective of mitigating the emergence of artemisinin resistance, which is a serious threat to malaria control and elimination, a pilot programme using multiple first-line therapies (MFTs) [three artemisinin-based combinations-pyronaridine-artesunate, dihydroartemisinin-piperaquine and artemether-lumefantrine] has been designed for implementation. As the success of this MFT pilot programme depends on the perceptions of key stakeholders in the health system and community members, the study aimed to assess their perceptions on the implementation of this strategy.
Semi-structured interviews, including 27 individual in-depth interviews and 41 focus groups discussions, were conducted with key stakeholders including malaria control policymakers and implementers, health system managers, health workers and community members. Volunteers from targets stakeholder groups were randomly selected. All interviews were recorded, transcribed and translated. Content analysis was performed using the qualitative software programme QDA Miner.
The interviews revealed a positive perception of stakeholders on the implementation of the planned MFT programme. They saw the strategy as an opportunity to strengthen the supply of anti-malarial drugs and improve the management of fever and malaria. However, due to lack of experience with the products, health workers and care givers expressed some reservations about the effectiveness and side-effect profiles of the two anti-malarial drugs included as first-line therapy in the MFT programme (pyronaridine-artesunate, dihydroartemisinin-piperaquine). Questions were raised about the appropriateness of segmenting the population into three groups and assigning a specific drug to each group.
The adherence of both populations and key stakeholders to the MFT implementation strategy will likely depend on the efficacy of the proposed drugs, the absence of, or low frequency of, side-effects, the cost of drugs and availability of the different combinations.
在布基纳法索，疟疾仍然是卫生中心就诊和住院的首要原因。该国卫生机构的疟疾一线病例管理基于使用青蒿素为基础的联合疗法（ACT）。为了优化这些抗疟药物的使用，以减轻青蒿素耐药性的出现，这对疟疾控制和消除构成了严重威胁，设计了一个使用多种一线疗法（MFT）[三种青蒿素为基础的组合-氨酚喹，双氢青蒿素-哌喹和青蒿琥酯-咯萘啶]的试点方案。由于该 MFT 试点方案的成功取决于卫生系统和社区成员中关键利益攸关方的看法，因此本研究旨在评估他们对该策略实施的看法。
对包括疟疾控制政策制定者和执行者、卫生系统管理者、卫生工作者和社区成员在内的关键利益攸关方进行了半结构式访谈，包括 27 次个人深入访谈和 41 次焦点小组讨论。从目标利益攸关方群体中随机选择志愿者。所有访谈均进行录音、转录和翻译。使用定性软件程序 QDA Miner 进行内容分析。
访谈显示，利益攸关方对计划中的 MFT 方案的实施持积极看法。他们认为该策略是加强抗疟药物供应和改善发热和疟疾管理的机会。然而，由于缺乏对产品的经验，卫生工作者和护理人员对 MFT 方案中包含的两种一线治疗药物（氨酚喹，双氢青蒿素-哌喹）的有效性和副作用特征表示保留意见。有人质疑将人群分为三组并为每组分配特定药物的适当性。
人口和关键利益攸关方对 MFT 实施策略的坚持很可能取决于拟议药物的疗效、副作用的有无或频率低、药物成本和不同组合的可用性。
