HIỆU QUẢ QUẢN LÝ BỆNH NHÂN SỐT RÉT TRONG ĐIỀU TRỊ CÓ GIÁM SÁT TRỰC TIẾP TRÊN NGƯỜI NHIỄM PLASMODIUM FALCIPARUM CHƯA BIẾN CHỨNG TẠI HUYỆN KRÔNG PA TỈNH GIA LAI, NĂM 2019-2020

Abstract

A controlled intervention study with the aim of evaluating the effectiveness of management of uncomplicated P.fal single infected between the “directly-observed therapy” and “self-administered therapy” groups in 4 communes belong to Krong Pa district, Gia Lai province during 2019-2020. 180 patients were selected into two study groups who were monoinfected with uncomplicated P.fal malaria parasite as microscopically confirmed. All patients with P.fal infection were treated with oral Pyronaridine-artesunate (Pyramax®) for 3 consecutive days plus a single-dose of primaquine on the first day. The study results showed that the adherence rate in the DOT group was 100%, which was 68.89% higher than that of the SAT group. The average of fever reduction in the DOT group was 24.5 ± 3.1 hours, shorter than in the SAT group was 48.8 ± 13.2 hours. The average of clearing parasites of clonal parasites in the DOT group was 48.6 ± 15.2 hours, shorter than in the SAT group was 87.1 ± 11.7 hours. The efficiency of clearing parasites at D₃ in the DOT group was 95.56%, higher than that of the SAT group of 78.89%. Patients in the SAT group were 5.75 times more likely to survive the parasite at D₃ with 95%CI (1.87 - 17.68) than in the DOT group, (p=0.002). The rate of reappearance of P.fal through follow-up at days D₇, D₁₄, D₁₄ and D₂₈ in the DOT group was 3.33%, much lower than in the SAT group of 28.89%. The rate of P.fal re-infection in the DOT group was 3.33%, 4.44% lower than the SAT group. The recurrence rate of P.fal in the DOT group was 0%, much lower than in the SAT group of 24.44%. The rate of cure and no recurrence of P.fal (up to day D₂₈) in the DOT group was 100%; much higher than the SAT group of 75.56%. The index of effectiveness in reducing the prevalence of P.fal infection in the DOT group was 97.03% (reduced from 2.02% to 0.06%), p<0.0001; in the SAT group was much lower, only 71.28% (down from 2.02% to 0.58%), p<0.0001. The intervention effect of “directly-observed therapy” was higher than that of “self-administered therapy”. The intervention efficiency reached 25.75%.