Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Tác động của quản lý sốt rét tại nhà đối với kết quả lâm sàng ở các quần thể châu Phi cận Sahara: một cuộc tổng quan hệ thống và phân tích meta
Tropical Medicine and Health - 2024
Tóm tắt
Sốt rét vẫn là nguyên nhân quan trọng gây bệnh tật và tử vong toàn cầu và tiếp tục ảnh hưởng không tương xứng đến dân số châu Phi. Chúng tôi nhằm đánh giá tác động của can thiệp quản lý sốt rét tại nhà đối với các kết quả sức khỏe. Trong tổng quan hệ thống và phân tích meta của chúng tôi, sáu cơ sở dữ liệu (Pubmed, Cochrane CENTRAL, EMBASE, CAB Abstracts and Global Health, CINAHL Complete và BIOSIS) đã được tìm kiếm cho các nghiên cứu về quản lý sốt rét tại nhà từ khi bắt đầu cho đến ngày 15 tháng 11 năm 2023. Chúng tôi đã đưa vào các nghiên cứu trước-sau, các nghiên cứu quan sát và các cuộc thử nghiệm ngẫu nhiên có đối chứng về can thiệp quản lý tại nhà được thực hiện trong bối cảnh cộng đồng. Các kết quả chính được xác định là tỷ lệ tử vong do sốt rét và tỷ lệ tử vong toàn bộ nguyên nhân. Nguy cơ thiên lệch trong từng nghiên cứu quan sát được đánh giá bằng công cụ ROBINS-I, trong khi các thử nghiệm ngẫu nhiên có đối chứng được đánh giá bằng công cụ đánh giá nguy cơ thiên lệch Cochrane đã được sửa đổi và các thử nghiệm ngẫu nhiên phân cụm được đánh giá bằng công cụ đánh giá nguy cơ thiên lệch Cochrane đã được điều chỉnh cho các thử nghiệm ngẫu nhiên phân cụm. Chúng tôi tính toán tỷ lệ rủi ro kèm theo khoảng tin cậy 95% cho các kết quả liên quan đến sức khỏe được báo cáo trong các nghiên cứu và sau đó tổng hợp các kết quả bằng cách sử dụng mô hình ngẫu nhiên (phương pháp DerSimonian–Laird). Chúng tôi xác định được 1203 tài liệu thông qua tìm kiếm trong cơ sở dữ liệu và tìm kiếm thủ công, trong đó có 56 bài báo từ 47 nghiên cứu với tổng cộng 234.002 người tham gia được đưa vào tổng quan hệ thống. Tất cả các nghiên cứu đều được thực hiện trên những người sống tại khu vực châu Phi cận Sahara và được đánh giá có nguy cơ thiên lệch thấp hoặc trung bình. Các phân tích tổng hợp cho thấy rằng tỷ lệ tử vong do sốt rét (RR = 0.40, 95% CI = 0.29–0.54, P = 0.00001, I2 = 0%) và tỷ lệ tử vong toàn bộ nguyên nhân (RR = 0.62, 95% CI = 0.53–0.72, P = 0.00001, I2 = 0%) ở những người tham gia nhận can thiệp quản lý tại nhà đã thấp hơn một cách có ý nghĩa so với nhóm đối chứng. Tuy nhiên, đối với trẻ em dưới 5 tuổi, không có sự khác biệt có ý nghĩa về tỷ lệ tử vong trước và sau khi triển khai quản lý sốt rét tại nhà. Về các kết quả thứ yếu, quản lý sốt rét tại nhà có liên quan đến sự giảm nguy cơ các đợt sốt (RR = 1.27, 95% CI = 1.09–1.47, P = 0.002, I2 = 97%) và tỷ lệ hiệu quả cao hơn của các phương pháp điều trị sốt rét (RR = 2.72, 95% CI = 1.90–3.88, P < 0.00001, I2 = 96%) so với chăm sóc tiêu chuẩn. Quản lý sốt rét tại nhà kết hợp với điều trị ngăn ngừa định kỳ cho thấy nguy cơ mắc sốt rét thấp hơn một cách có ý nghĩa so với can thiệp quản lý tại nhà chỉ cung cấp điều trị cho những cá nhân có triệu chứng sốt có khả năng là sốt rét. Nguy cơ phản ứng có hại được tìm thấy là tương tự cho các can thiệp quản lý tại nhà sử dụng các loại thuốc chống sốt rét khác nhau. Các phát hiện về chi phí- hiệu quả cho thấy quản lý sốt rét tại nhà cần được ưu tiên phát triển. Can thiệp quản lý sốt rét tại nhà có liên quan đến sự giảm đáng kể tỷ lệ tử vong do sốt rét và tỷ lệ tử vong toàn bộ nguyên nhân. Can thiệp này có thể giúp giảm gánh nặng sức khỏe và kinh tế do sốt rét. Cần có thêm các nghiên cứu lâm sàng để cho phép các giải thích có ý nghĩa hơn về việc triển khai quy mô lớn của can thiệp này, những bối cảnh với cường độ lây truyền khác nhau và các loại thuốc chống sốt rét mới.
Từ khóa
#sốt rét #quản lý tại nhà #châu Phi cận Sahara #phân tích meta #tỷ lệ tử vong #gánh nặng sức khỏeTài liệu tham khảo
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