背景:对非洲出现的对蒿甲醚-本特林(AL)的耐药性的担忧促使肯尼亚西部试点引入了多种一线疗法(MFT),育龄妇女(WOCBA)可能在妊娠早期暴露于安全性未知的抗疟药物。该研究在MFT试点的背景下评估了医疗保健提供者对妊娠期疟疾管理国家指南的了解和遵守情况。
方法:从2022年3月至4月,在50个医疗机构(HF)和40个药品网点(DO)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,和三个月的治疗选择。使用卡方检验评估HF和DO提供者之间以及MFT和非MFTHFs之间的差异。
结果:174个提供者(77%HF,23%DO),56%来自MFT试点设施。大多数提供者接受过高等教育;5%的HF和20%的DO仅接受过初等或中等教育。比DO提供者更多的HF对疟疾治疗指南有了解(62%与40%,p=0.023),在怀孕期间接受过疟疾培训(49%vs.20%,p=0.002),并报告了WOCBA中的怀孕评估(98%与78%,p<0.001)。大多数提供者坚持寄生虫学诊断,59%的HF使用显微镜和85%的DO使用快速诊断测试。比DO提供者更多的HF可以正确地命名用于治疗妊娠早期无并发症疟疾的药物(口服奎宁,或AL,如果奎宁不可用)(90%与58%,p<0.001),第二和第三个三个月(青蒿素为基础的联合治疗)(84%与70%,p=0.07),和严重疟疾(肠外青蒿琥酯/蒿甲醚)(94%vs.60%,p<0.001)。在HF提供商中,MFT飞行员对疟疾治疗指南有更多的了解(67%与49%,p=0.08),并接受了妊娠期疟疾治疗方面的培训(56%vs.32%,p=0.03)。很少有提供者(10%HF和12%DO)对怀孕期间的疟疾治疗有足够的了解,定义为在所有三个月中治疗无并发症和严重疟疾的正确药物和剂量。
结论:肯尼亚西部医疗服务提供者对国家妊娠疟疾治疗指南的了解并不理想。需要对适当的抗疟疾和剂量进行强有力的培训,特别是考虑到最近在孕早期推荐使用蒿甲醚-本美曲碱的变化。在MFT计划的背景下,对DO和HF实践的监督对于正确治疗妊娠期疟疾至关重要。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.