私营药店遵守国家疟疾治疗指南的情况：肯尼亚基苏木县疟疾流行地区的横断面调查。

Adherence to national malaria treatment guidelines in private drug outlets: a cross-sectional survey in the malaria-endemic Kisumu County, Kenya.

机构信息

Kisumu County Department of Health, Kisumu, Kenya.

School of Public Health, Moi University, Eldoret, Kenya.

出版信息

Malar J. 2023 Oct 11;22(1):307. doi: 10.1186/s12936-023-04744-7.

DOI:10.1186/s12936-023-04744-7

PMID:37821868

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10568760/

Abstract

BACKGROUND

Malaria prevalence in Kenya is 6%, with a three-fold higher prevalence in western Kenya. Adherence to malaria treatment guidelines improves care for suspected malaria cases and can reduce unnecessary anti-malarial use. Data on adherence to guidelines in retail drug outlets (DOs) is limited, yet approximately 50% of people with fever access treatment first in these outlets. This study assessed adherence to the national malaria treatment guidelines among DOs in a high transmission area of Western Kenya.

METHODS

In a cross-sectional survey of DOs in Kisumu Central and Seme sub-counties in 2021, DO staff were interviewed using structured questionnaires to assess outlet characteristics (location, testing services), staff demographics (age, sex, training), and health system context (supervision, inspection). Mystery shoppers (research assistants disguised as clients) observed malaria management practices and recorded observations on a standardized tool. Adherence was defined as dispensing artemether-lumefantrine (AL) to patients with a confirmed positive test, accompanied by appropriate medication counseling. Logistic regression was used to test for association between adherence to guidelines and DO-related factors.

RESULTS

None of the 70 DOs assessed had a copy of the guidelines, and 60 (85.7%) were in an urban setting. Staff adhered to the guidelines in 14 (20%) outlets. The odds of adherence were higher among staff who had a bachelor's degree {odds ratio (OR) 6.0, 95% confidence interval (95% CI) 1.66-21.74}, those trained on malaria rapid diagnostic test (RDT) {OR 4.4, 95% CI 1.29-15.04}, and those who asked about patient's symptoms {OR 3.6, 95% CI 1.08-12.25}. DOs that had higher odds of adherence included those with functional thermometers {OR 5.3, 95% CI 1.46-19.14}, those recently inspected (within three months) by Pharmacy and Poisons Board (PPB) {OR 9.4, 95% CI 2.55-34.67}, and those with all basic infrastructure {OR 3.9, 95% CI 1.01-15.00}. On logistic regression analysis, recent PPB inspection {adjusted OR (AOR) 4.6, 95% CI 1.03-20.77} and malaria RDT-trained staff (aOR 4.5, 95% CI 1.02-19.84) were independently associated with adherence.

CONCLUSION

Most outlets didn't adhere to malaria guidelines. Regular interaction with regulatory bodies could improve adherence. Ministry of Health should enhance private sector engagement and train DOs on RDT use.

摘要

背景

肯尼亚的疟疾患病率为 6%，其中西部肯尼亚的患病率高出三倍。遵守疟疾治疗指南可以改善疑似疟疾病例的护理，并减少不必要的抗疟药物使用。关于零售药店（DOs）中指南遵守情况的数据有限，但约有 50%的发热患者首先在这些网点接受治疗。本研究评估了肯尼亚西部高传播地区 DOs 中对国家疟疾治疗指南的遵守情况。

方法

在 2021 年对基苏木中央和 Seme 分区的 DOs 进行的横断面调查中，通过结构化问卷对 DO 工作人员进行访谈，以评估网点特征（位置、检测服务）、工作人员人口统计学特征（年龄、性别、培训）和卫生系统背景（监督、检查）。神秘顾客（伪装成客户的研究助理）观察疟疾管理做法，并在标准化工具上记录观察结果。将符合以下标准定义为符合指南：为确诊阳性测试的患者配发青蒿琥酯-甲氟喹（AL），并提供适当的用药咨询。使用逻辑回归检验指南遵守情况与 DO 相关因素之间的关联。

结果

在所评估的 70 家 DO 中，没有一家拥有指南副本，其中 60 家（85.7%）位于城市地区。在 14 家（20%）网点中，工作人员遵守了指南。具有学士学位的工作人员遵守指南的可能性更高（优势比[OR]6.0，95%置信区间[95%CI]1.66-21.74），接受过疟疾快速诊断检测（RDT）培训的工作人员（OR 4.4，95%CI 1.29-15.04），以及询问患者症状的工作人员（OR 3.6，95%CI 1.08-12.25）。具有更高遵守指南可能性的 DO 包括具有功能温度计的 DO（OR 5.3，95%CI 1.46-19.14），最近（在三个月内）受到药剂和毒药局（PPB）检查的 DO（OR 9.4，95%CI 2.55-34.67），以及具有所有基本基础设施的 DO（OR 3.9，95%CI 1.01-15.00）。在逻辑回归分析中，最近的 PPB 检查（调整后的 OR [AOR]4.6，95%CI 1.03-20.77）和接受过疟疾 RDT 培训的工作人员（AOR 4.5，95%CI 1.02-19.84）与遵守情况独立相关。