ABSTRACT
Malaria is assimilated with its cardinal symptom, i.e., fever. Treatment of fever with antimalarial drugs is crucial to the prevention of malaria-related death in Senegal. The objective of this study was to analyze fever-treatment practices as a basis for making realistic recommendations for self-treatment in the northern health district of Dakar, Senegal. This cross-sectional study was conducted from March 1 to April 30, 2003. The population included all patients with body temperature higher or equal to 37.5 degrees C (99.5 degrees F) associated with at least one of the following symptoms: headache, shivering, vomiting and diarrhoea. Study endpoints included demographic data and fever treatment modalities including the nature, dosage, and duration of the drugs used. Malaria was suspected in 180 of the 271 patients enrolled in the study. Treatment had already been undertaken in 134 patients including 108 (81%) who had initiated self-treatment. Drugs included antipyretics, antibiotics, and/or antimalarials. Antimalarial drug dosage was incorrect in 84% of those who initiated self-treatment. Dosage errors involved number of daily doses (55%), duration of treatment (13%), or both (32%). Only 45% of patients fully completed treatment. Medical advice was sought in 30% of the cases and drugs were obtained over the counter in pharmacies in 59%. Patients under the age of 15 years were significantly more likely to initiate self-treatment (p=6.10-6), to treat symptoms early, and to use an antimalarial (p=4.10-6). Although self-treatment shortened the delay between onset of symptoms and initiation of treatment, it is likely that indiscriminate and incomplete treatment is responsible for development of resistance to chloroquine in the northern health district of Dakar. Strategies must be adapted to numerous local factors influencing self-treatment including the availability of health-care services and drugs of quality. Special attention must be given to the improvement of antimalarial drug packaging and of the awareness of people that provide self-treatment drugs.
Subject(s)
Fever/drug therapy , Malaria/diagnosis , Malaria/drug therapy , Self Medication/statistics & numerical data , Adolescent , Adult , Antimalarials/administration & dosage , Antimalarials/therapeutic use , Child , Child, Preschool , Chloroquine/administration & dosage , Cross-Sectional Studies , Drug Resistance , Female , Humans , Infant , Malaria/mortality , Male , Middle Aged , SenegalABSTRACT
Le paludisme est assimile a son signe majeur; la fievre; dont le traitement avec un antipaludique est le moyen de prevention de la letalite au Senegal. L'objectif de cette etude est d'analyser les pratiques de traitement de la fievre en vue de formuler des recommandations realistes en matiere d'automedication dans le district nord de Dakar. Cette etude transversale a ete menee du 1er mars au 30 avril 2003. etaient inclus tous les patients qui ont consulte pour une fievre et qui presentaient une temperature corporelle superieure ou egale a 37;5oC associee au moins a l'un des symptomes suivants : cephalees; frissons; vomissements; diarrhee. Les variables etudiees portaient sur les caracteristiques individuelles; les demarches observees; la nature des medicaments utilises; et la conduite therapeutique. Sur 271 patients inclus; 180 ont ete suspects de paludisme. Un traitement avait deja ete entame pour 134 patients dont 108 (81) par automedication. Les medicaments utilises etaient un antipyretique; un antibiotique; et/ou un antipaludique. Le dosage a ete incorrect pour 84de ceux qui ont pris un antipaludique en automedication. Les erreurs de prise portaient sur la dose journaliere (55); la duree (13) ou sur les deux (32). La totalite des comprimes a ete prise par 45des clients. Le conseil etait obtenu du milieu sanitaire dans 30des cas; et les medicaments de la pharmacie dans 59. L'automedication a ete significativement plus frequente parmi les patients ages de moins de 15 ans (p=6;10-6) tout comme la precocite du traitement parmi ceux qui ont fait une automedication et; dans ce groupe; parmi ceux qui ont pris un antipaludique (p=4;10-6). Dans le district nord de Dakar; l'automedication de la fievre augmente la rapidite du traitement; mais sa mauvaise pratique pourrait etre responsable de pharmaco-resistance a la chloroquine. Les strategies doivent etre adoptees aux nombreux facteurs locaux qui peuvent influencer l'automedication; y compris l'acces aux services de sante; la disponibilite des medicaments de qualite; mais surtout le pre-conditionnement des antipaludiques et la sensibilisation des prescripteurs d'automedication
