RESUMO
Introducción. Se publican pocos estudios sobre las causas del retardo del diagnóstico y el tratamiento de la malaria en Bolivia. Objetivo. Conocer los factores que retardan el diagnóstico y el tratamiento de la malaria en el servicio público del municipio de Riberalta, Bolivia. Materiales y métodos. Se calcularon los tiempos transcurridos entre el inicio de los síntomas y el tratamiento, entre el inicio de los síntomas y el diagnóstico, y entre el diagnóstico y el inicio del tratamiento; se compararon las medias de los tiempos calculados con el lugar de infección, la especie parasitaria, el nivel de atención, el lugar y el método de diagnóstico, y la edad se correlacionó con los tiempos calculados. Resultados. De 2.482 casos positivos válidos evaluados entre enero y diciembre de 2010, se encontró una media de 4,16 días entre el inicio de los síntomas y el inicio del tratamiento, de 4,07 días entre el inicio de los síntomas y el diagnóstico, y de 0,10 días entre el diagnóstico y el tratamiento. El retardo del diagnóstico y los factores, lugar de diagnóstico, lugar de infección, nivel de atención, especie parasitaria y método de diagnóstico, mostraron una diferencia estadística significativa (p<0,05). En el análisis de la covarianza se observó una asociación estadística con el nivel de atención y la especie parasitaria (p<0,05) Conclusión. Existe un retardo en el diagnóstico de la malaria, lo cual es influenciado por factores como el lugar de infección, lugar del diagnóstico, nivel de atención, especie parasitaria y método de diagnóstico.
Introduction. Few studies on the causes of the delay of malaria diagnosis and treatment in Bolivia are published. Objective. To know the factors that delay malaria diagnosis and treatment of malaria in the public service of the town of Riberalta, Bolivia. Materials and methods. The times between the onset of symptoms and treatment, between the onset of symptoms and diagnosis and between the diagnosis and the start of treatment were calculated. The averages of the calculated times were compared with respect to the site of infection, parasite species, level of care, place of diagnosis and diagnostic method and th patient’s age was correlated with the calculated times. Results. Between January and December 2010, 2,482 positive valid cases were studied. An average of 4.16 days was found between the onset of symptoms and the start of treatment, the average time between the onset of symptoms and diagnosis was 4.07 days, and between diagnosis and the start of treatment 0.10 days. Statistically significant (p<0.05) differences were found for factors related to the delay of diagnosis such as place of diagnosis, site of infection, level of care, parasite species and diagnostic method. The analysis of covariance showed a statistical association with the level of care and the parasite species (p<0.05). Conclusion. The delay in malaria diagnosis is influenced by factors such as the site of infection, place of diagnosis, level of care, parasite species and diagnostic method.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Diagnóstico Tardio , Malária/diagnóstico , Malária/terapia , Bolívia , Estudos Retrospectivos , Fatores de TempoRESUMO
Introducción. La determinación de la eficacia de la cloroquina contra Plasmodium vivax permite mejorar la capacidad de vigilancia de la resistencia a los antipalúdicos. Objetivo. Evaluar la eficacia terapéutica de la cloroquina como tratamiento de malaria no complicadapor P. vivax en Riberalta, Guayaramerín y Yacuiba, Bolivia. Materiales y métodos. Se llevó a cabo un estudio de la eficacia in vivo en pacientes mayores de cinco años; se suministró cloroquina (25 mg/kg en tres días) y se hizo seguimiento por 28 días, midiendo los niveles de cloroquina en sangre y desetilcloroquina, el día dos y el día de registro de reaparición de parasitemia. Para la evaluación de la incidencia acumulada de falla del tratamiento, se usó el análisis de supervivencia de Kaplan-Meier. Resultados. Se estudiaron 223 pacientes (Riberalta, 84; Guayaramerín, 80; Yacuiba, 59). Las medias de densidad parasitaria (formas asexuadas) del día 0 en Riberalta fueron de 6.147, en Guayaramerín, 4.251, y en Yacuiba, 5.214 parásitos/μl de sangre. En el mismo orden, los promedios de concentraciones sanguíneas de cloroquina-desetilcloroquina del día 2 fueron de 783, 817 y 815 ng/ml. Mientras en Yacuiba no se presentaron fracasos terapéuticos, en Riberalta ocurrieron con frecuencia de 6,2 % y en Guayaramerín de 10 %. Los valores de cloroquina y desetilcloroquina en sangre de pacientes con fracaso terapéutico fueron menores de 70 ng/ml en el día de reaparición de parasitemia. Conclusión. No se evidenció resistencia de P. vivax a la cloroquina en las tres regiones de evaluación en Bolivia. Se requieren mayores estudios de la concentración de la cloroquina en sangre.
Introduction. Knowledge of the therapeutic efficacy of chloroquine for Plasmodium vivax infections improves the capacity for surveillance of anti-malarial drug resistance. Objective. The therapeutic efficacy of chloroquine as treatment was evaluated for uncomplicated Plasmodium vivax malaria in Bolivia. Materials and methods. An in vivo efficacy study of chloroquine was undertaken in three regions of Bolivia--Riberalta, Guayaramerín and Yacuiba. Two hundred and twenty-three patients (84, 80, and 59 in the three regions, respectively) aged over 5 years old were administered with chloroquine (25 mg/kg/three days) and followed for 28 days. Blood levels of chloroquine and desethylchloroquine were measured on day 2 and on the day of reappearance of parasitemia. The cumulative incidence of treatment failure was calculated using the Kaplan and Meier survival analysis. Results. The mean parasitemias (asexual) on day 0 were 6,147 parasites/μl of blood in the Riberalta population, 4,251 in Guayaramerín and 5,214 in Yacuiba. The average blood concentrations of chloroquine-desethylchloroquine during day 2 were 783, 817, and 815 ng/ml, respectively. No treatment failures were observed in Yacuiba, whereas in Riberalta and Guayaramerín, the frequencies of treatment failures were 6.2% and 10%. Blood levels of chloroquine and desethylchloroquine in patients with treatment failure showed values below 70 ng/ml on the day of reappearance of parasitemia. Conclusion. Resistance of Plasmodium vivax to chloroquine was not demonstrated in three regions of Bolivia.
Assuntos
Adolescente , Adulto , Animais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Adulto Jovem , Antimaláricos/uso terapêutico , Cloroquina/uso terapêutico , Malária Vivax/tratamento farmacológico , Parasitemia/tratamento farmacológico , Plasmodium vivax/efeitos dos fármacos , Antimaláricos/sangue , Bolívia/epidemiologia , Cloroquina/análogos & derivados , Cloroquina/sangue , Resistência a Medicamentos , Malária Vivax/epidemiologia , Malária Vivax/parasitologia , Carga Parasitária , Parasitemia/epidemiologia , Parasitemia/parasitologia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/parasitologia , População RuralRESUMO
Background: Ensuring the quality of malaria medicines is crucial in working toward malaria control and eventual elimination. Unlike other validated tests that can assess all critical quality attributes, which is the standard for determining the quality of medicines, basic tests are significantly less expensive, faster, and require less skilledlabour; yet, these tests provide reproducible data and information on several critical quality attributes, such asidentity, purity, content, and disintegration. Visual and physical inspection also provides valuable information aboutthe manufacturing and the labelling of medicines, and in many cases this inspection is sufficient to detectcounterfeit medicines. The Promoting the Quality of Medicines (PQM) programme has provided technical assistanceto Amazon Malaria Initiative (AMI) countries to implement the use of basic tests as a key screening mechanism toassess the quality of malaria medicines available to patients in decentralized regions.Methods: Trained personnel from the National Malaria Control Programmes (NMCPs), often in collaboration with countrys Official Medicine Control Laboratory (OMCL), developed country- specific protocols that encompassed sampling methods, sample analysis, and data reporting. Sampling sites were selected based on malaria burden,accessibility, and geographical location. Convenience sampling was performed and countries were recommendedto store the sampled medicines under conditions that did not compromise their quality. Basic analytical tests, suchas disintegration and thin layer chromatography (TLC), were performed utilizing a portable mini-laboratory...(AU)