背景:卫生工作者对门诊疟疾病例管理指南的依从性一直在提高,特别是关于对疑似病例的普遍测试和仅对阳性结果使用基于青蒿素的联合治疗(ACT)(即,\'测试和治疗\')。是否符合“测试和治疗”指南的改进在不同的疟疾流行地区是一致的,尚未审查。
方法:数据来自11个国家,横截面,对2010-2016年在肯尼亚开展的门诊疟疾病例管理调查进行了分析.四个主要指标(即,\'testandtreat\')and8secondaryindicatorsofartemether-lumefantrine(AL)detection,配药,和咨询被测量。使用混合逻辑回归模型来分析不同疟疾流行地区指标的年度趋势(即,从最高风险到最低风险是湖泊特有的,海岸特有的,高原疫情,半干旱季节性传播,和低风险)。
结果:在疟疾风险最高的地区,对所有四个“测试和治疗”指标的合规性显着提高(即,湖泊地方性)如下:发热患者的检测(每年OR=1.71;95%CI=1.51-1.93),检测阳性患者的AL治疗(OR=1.56;95%CI=1.26-1.92),检测阴性患者无抗疟疾(OR=2.04;95%CI=1.65-2.54),和复合测试和治疗依从性(OR=1.80;95%CI=1.61-2.01)。在低风险地区,只有对检测阴性结果的依从性显著增加(OR=2.27;95%CI=1.61-3.19),而对发热患者的检测呈下降趋势(OR=0.89;95%CI=0.79-1.01).在湖泊特有地区,首次AL剂量的施用显着增加(OR=2.33;95%CI=1.76-3.10),海岸地方性(OR=5.02;95%CI=2.77-9.09)和半干旱季节性传播(OR=1.44;95%CI=1.02-2.04)。在传播风险最低的地区和高原疫区,没有AL给药,配药,咨询任务随着时间的推移发生了显著变化。
结论:肯尼亚不同疟疾风险地区的卫生工作者对门诊疟疾病例管理指南的依从性存在差异。在低风险地区,最高风险地区没有出现重大改善。改进做法的干预措施应具有地域针对性。
BACKGROUND: Health workers\' compliance with outpatient malaria case-management guidelines has been improving, specifically regarding the universal testing of suspected cases and the use of artemisinin-based combination therapy (ACT) only for positive results (i.e., \'test and treat\'). Whether the improvements in compliance with \'test and treat\' guidelines are consistent across different malaria endemicity areas has not been examined.
METHODS: Data from 11 national, cross-sectional, outpatient malaria case-management surveys undertaken in Kenya from 2010 to 2016 were analysed. Four primary indicators (i.e., \'test and treat\') and eight secondary indicators of artemether-lumefantrine (AL) dosing, dispensing, and counselling were measured. Mixed logistic regression models were used to analyse the annual trends in compliance with the indicators across the different malaria endemicity areas (i.e., from highest to lowest risk being lake endemic, coast endemic, highland epidemic, semi-arid seasonal transmission, and low risk).
RESULTS: Compliance with all four \'test and treat\' indicators significantly increased in the area with the highest malaria risk (i.e., lake endemic) as follows: testing of febrile patients (OR = 1.71 annually; 95% CI = 1.51-1.93), AL treatment for test-positive patients (OR = 1.56; 95% CI = 1.26-1.92), no anti-malarial for test-negative patients (OR = 2.04; 95% CI = 1.65-2.54), and composite \'test and treat\' compliance (OR = 1.80; 95% CI = 1.61-2.01). In the low risk areas, only compliance with test-negative results significantly increased (OR = 2.27; 95% CI = 1.61-3.19) while testing of febrile patients showed declining trends (OR = 0.89; 95% CI = 0.79-1.01). Administration of the first AL dose at the facility significantly increased in the areas of lake endemic (OR = 2.33; 95% CI = 1.76-3.10), coast endemic (OR = 5.02; 95% CI = 2.77-9.09) and semi-arid seasonal transmission (OR = 1.44; 95% CI = 1.02-2.04). In areas of the lowest risk of transmission and highland epidemic zone, none of the AL dosing, dispensing, and counselling tasks significantly changed over time.
CONCLUSIONS: There is variability in health workers\' compliance with outpatient malaria case-management guidelines across different malaria-risk areas in Kenya. Major improvements in areas of the highest risk have not been seen in low-risk areas. Interventions to improve practices should be targeted geographically.