有证据表明,健康状况不佳的儿童不太可能上学或完成学业。疟疾是学龄儿童发病和死亡的重要原因。然而,他们在医疗设施中接受疟疾治疗的可能性较小,并且关于如何改善学童获得护理的证据有限。本研究旨在评估以学校为基础的疟疾病例管理计划对学童出勤率的影响,健康和教育。
一项整群随机对照试验在松巴区的58所小学进行,马拉维,2011-2015。干预,在29所随机选择的学校中实施,提供疟疾快速诊断测试和基于青蒿素的联合疗法,以诊断和治疗无并发症的疟疾,作为称为“学习者治疗试剂盒”(LTK)的基本急救包的一部分。主要结果是入学率,通过教师记录的每日出勤登记册和独立的定期出勤抽查进行评估。次要结果包括疟原虫感染的患病率,贫血,教育表现,自我报告的儿童福祉和寻求健康的行为。从标准1-7中随机抽取9571名儿童进行入学率评估,对次要结局进行子样本评估。在2013年11月至2015年3月期间,29所学校的97名经过培训的教师提供了32685次独特咨询。女学童寻求咨询的可能性明显高于男性(未调整OR=1.78(95%CI1.58至2.00)。对教师登记册中记录为缺席的儿童天数比例没有观察到显著的干预效果(n=9017OR=0.90(95%CI0.77~1.05),p=0.173)或在随机学校访问期间缺席的儿童-抽查(n=5791OR=1.09(95%CI0.87至1.36),p=0.474)。对儿童报告的幸福感没有重大影响,疟原虫的流行,贫血或教育分数。
尽管社区需求很高,在本研究环境中,LTK项目并未减少学童的缺勤或改善健康或教育结果.
ClinicalTrials.govNCT02213211。
Evidence indicates children who suffer from ill-health are less likely to attend or complete schooling. Malaria is an important cause of morbidity and mortality in school-age children. However, they are less likely to receive malaria treatment at health facilities and evidence for how to improve schoolchildren\'s access to care is limited. This study aimed to evaluate the impact of a programme of school-based malaria
case management on schoolchildren\'s attendance, health and education.
A cluster randomised controlled trial was conducted in 58 primary schools in Zomba District, Malawi, 2011-2015. The intervention, implemented in 29 randomly selected schools, provided malaria rapid diagnostic tests and artemisinin-based combination therapy to diagnose and treat uncomplicated malaria as part of basic first aid kits known as \'Learner Treatment Kits\' (LTK). The primary outcome was school attendance, assessed through teacher-recorded daily attendance registers and independent periodic attendance spot checks. Secondary outcomes included prevalence of Plasmodium spp infection, anaemia, educational performance, self-reported child well-being and health-seeking behaviour. A total of 9571 children from standards 1-7 were randomly selected for assessment of school attendance, with subsamples assessed for the secondary outcomes.
Between November 2013 and March 2015, 97 trained teachers in 29 schools provided 32 685 unique consultations. Female schoolchildren were significantly more likely than male to seek a consultation (unadjusted OR=1.78 (95% CI 1.58 to 2.00). No significant intervention effect was observed on the proportion of child-days recorded as absent in teacher registers (n=9017 OR=0.90 (95% CI 0.77 to 1.05), p=0.173) or of children absent during random school visits-spot checks (n=5791 OR=1.09 (95% CI 0.87 to 1.36), p=0.474). There was no significant impact on child-reported well-being, prevalence of Plasmodium spp, anaemia or education scores.
Despite high community demand, the LTK programme did not reduce schoolchildren\'s absenteeism or improve health or education outcomes in this study setting.
ClinicalTrials.gov NCT02213211.