Patients with positive malaria tests not given artemisinin-based combination therapies: a research synthesis describing under-prescription of antimalarial medicines in Africa.

Autor: O'Boyle S; London School of Hygiene and Tropical Medicine, London, UK. shennae.oboyle@lshtm.ac.uk., Bruxvoort KJ; London School of Hygiene and Tropical Medicine, London, UK.; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA., Ansah EK; Centre for Malaria Research, University of Health and Allied Sciences, Accra, Ghana., Burchett HED; London School of Hygiene and Tropical Medicine, London, UK., Chandler CIR; London School of Hygiene and Tropical Medicine, London, UK., Clarke SE; London School of Hygiene and Tropical Medicine, London, UK., Goodman C; London School of Hygiene and Tropical Medicine, London, UK., Mbacham W; Public Health Biotechnology, University of Yaoundé I, Yaoundé, Cameroon., Mbonye AK; Makerere University School of Public Health, Kampala, Uganda., Onwujekwe OE; Department of Pharmacology and Therapeutics, University of Nigeria, Enugu, Nigeria., Staedke SG; London School of Hygiene and Tropical Medicine, London, UK., Wiseman VL; London School of Hygiene and Tropical Medicine, London, UK.; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia., Whitty CJM; London School of Hygiene and Tropical Medicine, London, UK., Hopkins H; London School of Hygiene and Tropical Medicine, London, UK.
Jazyk: angličtina
Zdroj: BMC medicine [BMC Med] 2020 Jan 30; Vol. 18 (1), pp. 17. Date of Electronic Publication: 2020 Jan 30.
DOI: 10.1186/s12916-019-1483-6
Abstrakt: Background: There has been a successful push towards parasitological diagnosis of malaria in Africa, mainly with rapid diagnostic tests (mRDTs), which has reduced over-prescribing of artemisinin-based combination therapies (ACT) to malaria test-negative patients. The effect on prescribing for test-positive patients has received much less attention. Malaria infection in endemic Africa is often most dangerous for young children and those in low-transmission settings. This study examined non-prescription of antimalarials for patients with malaria infection demonstrated by positive mRDT results, and in particular these groups who are most vulnerable to poor outcomes if antimalarials are not given.
Methods: Analysis of data from 562,762 patients in 8 studies co-designed as part of the ACT Consortium, conducted 2007-2013 in children and adults, in Cameroon, Ghana, Nigeria, Tanzania, and Uganda, in a variety of public and private health care sector settings, and across a range of malaria endemic zones.
Results: Of 106,039 patients with positive mRDT results (median age 6 years), 7426 (7.0%) were not prescribed an ACT antimalarial. The proportion of mRDT-positive patients not prescribed ACT ranged across sites from 1.3 to 37.1%. For patients under age 5 years, 3473/44,539 (7.8%) were not prescribed an ACT, compared with 3833/60,043 (6.4%) of those aged ≥ 5 years. The proportion of < 5-year-olds not prescribed ACT ranged up to 41.8% across sites. The odds of not being prescribed an ACT were 2-32 times higher for patients in settings with lower-transmission intensity (using test positivity as a proxy) compared to areas of higher transmission. mRDT-positive children in low-transmission settings were especially likely not to be prescribed ACT, with proportions untreated up to 70%. Of the 7426 mRDT-positive patients not prescribed an ACT, 4121 (55.5%) were prescribed other, non-recommended non-ACT antimalarial medications, and the remainder (44.5%) were prescribed no antimalarial.
Conclusions: In eight studies of mRDT implementation in five African countries, substantial proportions of patients testing mRDT-positive were not prescribed an ACT antimalarial, and many were not prescribed an antimalarial at all. Patients most vulnerable to serious outcomes, children < 5 years and those in low-transmission settings, were most likely to not be prescribed antimalarials, and young children in low-transmission settings were least likely to be treated for malaria. This major public health risk must be addressed in training and practice.
Trial Registration: Reported in individual primary studies.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje