Centre for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578, Kisumu, 40100, Kenya.
Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.
Malar J. 2023 Sep 8;22(1):262. doi: 10.1186/s12936-023-04692-2.
Concerns about emerging resistance to artemether-lumefantrine (AL) in Africa prompted the pilot introduction of multiple first-line therapies (MFT) in Western Kenya, potentially exposing women-of-childbearing-age (WOCBA) to anti-malarials with unknown safety profiles in the first trimester. The study assessed healthcare provider knowledge and adherence to national guidelines for managing malaria in pregnancy in the context of the MFT pilot.
From March to April 2022, a cross-sectional study was conducted in 50 health facilities (HF) and 40 drug outlets (DO) using structured questionnaires to assess pregnancy detection, malaria diagnosis, and treatment choices by trimester. Differences between HF and DO providers and between MFT and non-MFT HFs were assessed using Chi-square tests.
Of 174 providers (77% HF, 23% DO), 56% were from MFT pilot facilities. Most providers had tertiary education; 5% HF and 20% DO had only primary or secondary education. More HF than DO providers had knowledge of malaria treatment guidelines (62% vs. 40%, p = 0.023), received training in malaria in pregnancy (49% vs. 20%, p = 0.002), and reported assessing for pregnancy in WOCBA (98% vs. 78%, p < 0.001). Most providers insisted on parasitological diagnosis, with 59% HF using microscopy and 85% DO using rapid diagnostic tests. More HF than DO providers could correctly name the drugs for treating uncomplicated malaria in the first trimester (oral quinine, or AL if quinine is unavailable) (90% vs. 58%, p < 0.001), second and third trimesters (artemisinin-based combination therapy) (84% vs. 70%, p = 0.07), and for severe malaria (parenteral artesunate/artemether) (94% vs. 60%, p < 0.001). Among HF providers, those in the MFT pilot had more knowledge of malaria treatment guidelines (67% vs. 49%, p = 0.08) and had received training on treatment of malaria in pregnancy (56% vs. 32%, p = 0.03). Few providers (10% HF and 12% DO) had adequate knowledge of malaria treatment in pregnancy, defined as the correct drug and dose for uncomplicated and severe malaria in all trimesters.
Knowledge of national malaria in pregnancy treatment guidelines among providers in Western Kenya is suboptimal. Robust training on appropriate anti-malarial and dosage is needed, particularly given the recent change in recommendation for artemether-lumefantrine use in the first trimester. Supervision of DO and HF practices is essential for correct treatment of malaria in pregnancy in the context of MFT programmes.
由于对非洲青蒿素-哌喹（AL）耐药性的担忧，肯尼亚西部率先引入了多种一线治疗药物（MFT），这可能使育龄妇女（WOCBA）在妊娠早期接触到安全性未知的抗疟药物。本研究评估了在 MFT 试点背景下，医疗保健提供者对国家妊娠疟疾管理指南的知识和遵循情况。
2022 年 3 月至 4 月，在 50 个卫生机构（HF）和 40 个药物销售点（DO）中进行了一项横断面研究，使用结构化问卷评估妊娠检测、疟疾诊断和各孕期的治疗选择。使用卡方检验评估 HF 和 DO 提供者之间以及 MFT 和非 MFT HF 之间的差异。
在 174 名提供者（77% HF，23% DO）中，56%来自 MFT 试点机构。大多数提供者接受过高等教育；5% HF 和 20% DO 仅接受过小学或中学教育。与 DO 提供者相比，HF 提供者对疟疾治疗指南的了解更多（62% vs. 40%，p=0.023），接受过疟疾妊娠培训（49% vs. 20%，p=0.002），并报告在 WOCBA 中评估妊娠情况（98% vs. 78%，p<0.001）。大多数提供者坚持寄生虫学诊断，59% HF 使用显微镜，85% DO 使用快速诊断测试。与 DO 提供者相比，HF 提供者能更正确地命名治疗早孕（口服奎宁，或无奎宁时使用 AL）（90% vs. 58%，p<0.001）、中孕和晚孕（青蒿素类复方疗法）（84% vs. 70%，p=0.07）和治疗重症疟疾（注射用青蒿琥酯/蒿甲醚）（94% vs. 60%，p<0.001）的药物。在 HF 提供者中，MFT 试点参与者对疟疾治疗指南的了解更多（67% vs. 49%，p=0.08），并且接受过疟疾妊娠治疗培训（56% vs. 32%，p=0.03）。只有少数提供者（10% HF 和 12% DO）对妊娠疟疾治疗有足够的了解，即所有孕期治疗早孕和重症疟疾的正确药物和剂量。
肯尼亚西部的提供者对国家妊娠疟疾治疗指南的了解不足。需要进行关于适当抗疟药物和剂量的强化培训，特别是鉴于最近推荐在早孕中使用青蒿素-哌喹。对 DO 和 HF 实践进行监督，对于 MFT 方案中妊娠疟疾的正确治疗至关重要。
