Svege Sarah, Lange Siri, Robberstad Bjarne, Rujumba Joseph
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
PLOS Glob Public Health. 2025 Jul 9;5(7):e0004056. doi: 10.1371/journal.pgph.0004056. eCollection 2025.
Patients with sickle cell anaemia (SCA) are at risk of severe illness and death if infected by malaria, and lifelong prophylaxis is recommended to individuals in malaria endemic regions. Although its efficacy is declining due to parasite resistance, the antimalarial drug Sulphadoxine-Pyrimethamine (SP) is still given to patients with SCA in several countries of sub-Saharan Africa. A clinical trial was performed to compare SP with Dihydroartemisinin-Piperaquine (DP) for malaria chemoprevention in children with SCA in Uganda and Malawi. This paper describes a study on acceptability which was nested within the trial. To explore views on malaria chemoprevention and the proposed treatment regimens, 29 focus group discussions were conducted with children above 10 years of age with SCA and caregivers of children with SCA. The discussions were transcribed and translated to English before coding and reflexive thematic analysis. Participants from the DP arm reported a reduced number of sick events and hospital admissions while they were in the trial, and ranked DP above SP in terms of perceived effectiveness. Although concerns were raised about initial side effects, a high pill burden, and the unpleasant smell and taste of tablets, most participants were willing to continue long-term administration of DP due to its observed or experienced health benefits. Despite positive attitudes towards the use of weekly DP, monthly dosing was frequently suggested as a better option as it would lower the pill burden and expand the time interval between treatment courses. To mitigate transport costs and time spent away from school and work, most participants preferred a period of two months or longer between drug refill visits at the hospital. During routine care visits, counselling about the importance of accurate dosing and ongoing adherence should be provided to ensure sustainable and successful use of malaria chemoprevention among children with SCA.
镰状细胞贫血（SCA）患者若感染疟疾，有患重病和死亡的风险，因此建议疟疾流行地区的个体进行终身预防。尽管由于寄生虫耐药性，抗疟药物磺胺多辛 - 乙胺嘧啶（SP）的疗效在下降，但撒哈拉以南非洲的几个国家仍将其用于SCA患者。在乌干达和马拉维进行了一项临床试验，比较SP与双氢青蒿素 - 哌喹（DP）对SCA儿童疟疾化学预防的效果。本文描述了一项嵌套在该试验中的关于可接受性的研究。为了探究对疟疾化学预防和拟议治疗方案的看法，对10岁以上的SCA儿童及其照顾者进行了29次焦点小组讨论。讨论内容在编码和反思性主题分析之前进行了转录并翻译成英文。来自DP组的参与者报告称，在试验期间他们的患病事件和住院次数有所减少，并且在感知有效性方面将DP排在SP之上。尽管有人对初始副作用、高药丸负担以及片剂难闻的气味和味道表示担忧，但由于观察到或体验到的健康益处，大多数参与者愿意继续长期服用DP。尽管对每周服用DP持积极态度，但经常有人建议每月给药是更好的选择，因为这样可以降低药丸负担并延长疗程之间的时间间隔。为了降低交通成本以及减少缺课和误工时间，大多数参与者更喜欢在医院再次取药之间间隔两个月或更长时间。在常规护理就诊期间，应提供关于准确给药和持续坚持用药重要性的咨询，以确保SCA儿童能够持续且成功地进行疟疾化学预防。
