Ezenyi Ifeoma C, Picozzi Kim, Amaka John I, Adigwe Obi P
Department of Pharmacology and Toxicology, National Institute for Pharmaceutical Research and Development, Federal Ministry of Health, Abuja, Nigeria.
Malariaworld J. 2024 Oct 15;15:11. doi: 10.5281/zenodo.13934643. eCollection 2024.
Malaria is a leading cause of mortality in children aged 5 years and below in Nigeria. Treatment guidelines stipulate among other recommendations, testing by microscopy or a rapid diagnostic test (RDT) before treatment. Non-adherence to these guidelines portends a challenge, especially among vulnerable under-five children. This study explored the factors influencing Nigerian public health workers' (HWs) adherence to these guidelines in under-five children.
A review of literature published between 2011- 2023 was conducted on Web of Science, Ovid Embase, Medline, Global Health, CAB Abstracts, Scopus, and Global Index Medicus. Data was extracted and analyzed under 4 themes: diagnosis, compliance with test results, use of recommended treatment, post-treatment counselling and severe malaria management.
Nineteen (19) studies were included for review. Training and supervision, RDT and antimalarial availability, good knowledge of, and positive perception of RDTs promoted adherence to mRDT use. A lack of confidence in RDTs and age (≥ 40 years) fuelled presumptive treatment, especially among clinicians. mRDT and artemisinin-based combination therapy (ACT) stockouts dissuaded HWs from adhering to case management guidelines. Caregiver pressure for treatment was identified as a barrier to compliance with test results.
It is important to design context-specific strategies to improve adherence to guidelines for malaria case management, especially in under-five children. Training on the guidelines should be tailored, needs-based, and continuous, and HWs should be supportively supervised in implementing case management. Maintaining an adequate supply of quality-assured mRDTs and antimalarials can facilitate adherence to the guidelines.
疟疾是尼日利亚5岁及以下儿童死亡的主要原因。治疗指南规定了多项建议，其中包括在治疗前通过显微镜检查或快速诊断检测（RDT）进行检测。不遵守这些指南带来了挑战，尤其是在5岁以下的弱势儿童中。本研究探讨了影响尼日利亚公共卫生工作者（HWs）在5岁以下儿童中遵守这些指南的因素。
在科学网、Ovid Embase、Medline、全球健康、CAB文摘、Scopus和全球医学索引上对2011年至2023年发表的文献进行了综述。数据在4个主题下进行提取和分析：诊断、对检测结果的依从性、推荐治疗的使用、治疗后咨询和重症疟疾管理。
纳入19项研究进行综述。培训与监督、RDT和抗疟药物的可获得性、对RDT的良好了解以及积极认知促进了对mRDT使用的依从性。对RDT缺乏信心以及年龄（≥40岁）助长了推定治疗，尤其是在临床医生中。mRDT和青蒿素联合疗法（ACT）缺货使卫生工作者不愿遵守病例管理指南。照顾者对治疗施压被确定为遵守检测结果的障碍。
设计针对具体情况的策略以提高对疟疾病例管理指南的依从性非常重要，尤其是在5岁以下儿童中。关于指南的培训应量身定制、基于需求且持续进行，并且在实施病例管理时应对卫生工作者进行支持性监督。维持充足的质量有保证的mRDT和抗疟药物供应有助于遵守指南。
