Schlagenhauf P, Steffen R, Tschopp A, Van Damme P, Mittelholzer M L, Leuenberger H, Reinke C
Division of Communicable Diseases, University of Zurich, Switzerland.
Bull World Health Organ. 1995;73(2):215-21.
The use of stand-by treatment for malaria by travellers depends on their knowledge, attitudes and behaviour. We examined the behavioural aspects of a cohort of travellers from Switzerland to low-risk malarial areas who, on recruitment, were provided with a kit containing medication for stand-by treatment, guidelines on the diagnosis of malaria, and materials for collection of blood samples for later confirmation of malaria. All subjects were urged to seek medical advice at the first signs of possible malarial symptoms. Illness (fever as the main indicator) was reported by 123 of the 1187 participants, often accompanied by shivering/chills (36.6%), headache (35.0%), gastrointestinal symptoms (69.9%), and myalgia and/or arthralgia (41.5%). Two-thirds of those ill failed to seek medical attention despite their symptoms and pretravel advice. Only 9 (7.3%) were actually beyond the reach of medical attention. The stand-by treatment was self-administered by 6 travellers, only one of whom had confirmed malaria. Two non-serious adverse events were reported. All users consulted a physician after administering the presumptive treatment. This stand-by approach is limited by inappropriate behaviour and poor malaria awareness among travellers. These negative factors can be mitigated by development of an improved kit containing a simple test for self-diagnosis.
旅行者对疟疾采用备用治疗的情况取决于他们的知识、态度和行为。我们研究了一组从瑞士前往低风险疟疾地区的旅行者的行为情况，这些旅行者在招募时收到了一个装有备用治疗药物、疟疾诊断指南以及用于采集血样以便日后确认疟疾的材料的试剂盒。所有受试者都被敦促在出现可能的疟疾症状的最初迹象时寻求医疗建议。1187名参与者中有123人报告患病（以发热为主要指标），常伴有寒战/发冷（36.6%）、头痛（35.0%）、胃肠道症状（69.9%）以及肌痛和/或关节痛（41.5%）。三分之二患病者尽管有症状且收到了旅行前的建议，但仍未寻求医疗帮助。只有9人（7.3%）实际上无法获得医疗服务。6名旅行者自行使用了备用治疗药物，其中只有1人确诊感染疟疾。报告了两起不严重的不良事件。所有使用者在进行推定治疗后都咨询了医生。这种备用治疗方法受到旅行者行为不当和疟疾意识淡薄的限制。通过开发一种包含自我诊断简易检测方法的改进试剂盒，可以缓解这些负面因素。
