BACKGROUND The Democratic Republic of the Congo adopted the strategy of using, at the community level, a dose of rectal artesunate as a pre-referral treatment for severe malaria amongst children under 5 years who could not quickly reach a health care facility and take oral medication. However, the adherence to referral advice after the integration of this strategy and the acceptability of the strategy were unknown. METHODS To assess adherence by the mothers/caretakers of children under 5 years to referral advice provided by the community health workers after pre-referral treatment of severe malaria with rectal artesunate, the authors conducted a noninferiority community trial with a pre- and post-intervention design in 63 (pre-intervention) and 51 (post-intervention) community care sites in 4 provinces (Kasaï-Oriental, Kasaï-Central, Lomami, Lualaba) from August 2014 through June 2016. The pre- and post-intervention surveys targets 387 mothers of children under 5 years and 63 community health workers and 346 mothers and 41 community health workers, respectively. A 15% margin was considered for noninferiority analyses due to the expected decrease in adherence to referral advice after the introduction of the new intervention. RESULTS The mothers acknowledged that the rectal route was often used (60.7%), and medicines given rectally were considered more effective (63.6%) and easy to administer (69.7%). The acceptability of pre-referral rectal artesunate was relatively high: 79.4% (95% CI 75.4-83.3) among mothers, 90.3% (95% CI 82.3-96.8) among community health workers, and 97.8% (95% CI 93.3-100) among nurses. Adherence to referral advice at post-intervention [84.3% (95% CI 80.6-88.1)] was non-inferior to pre-intervention adherence [94.1% (95% CI 91.7-96.4)]. CONCLUSIONS The integration of pre-referral rectal artesunate for severe malaria into the community care site in the DR Congo is feasible and acceptable. It positively affected adherence to referral advice. However, more health education is needed for parents of children under 5 years and community health workers.

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引入青蒿琥酯用于社区一级严重疟疾的转诊前治疗后，应遵守转诊建议：刚果民主共和国的一项非劣效性试验。

背景技术刚果民主共和国采取了以下策略：在社区一级使用一定剂量的青蒿琥酯作为转诊前治疗无法迅速到达医疗机构并服用口服药物的5岁以下儿童中的严重疟疾的方法。 。但是，在整合该策略后是否坚持推荐咨询意见以及该策略的可接受性尚不清楚。方法为了评估5岁以下儿童的母亲/看护人在直肠青蒿琥酯转诊严重疟疾后对社区卫生工作者提供的转诊建议的依从性，作者进行了一项非劣势社区试验，包括干预前后在4个省（东卡萨伊，卡萨中央，洛马米，从2014年8月至2016年6月。干预前后的调查分别针对387名5岁以下儿童的母亲和63名社区卫生工作者，以及346名母亲和41名社区卫生工作者。对于非劣效性分析，考虑了15％的利润，这是由于在采用新干预措施后，对转诊咨询的依从性预计会下降。结果母亲们承认，经常使用直肠途径（60.7％），经直肠给药被认为更有效（63.6％）且易于管理（69.7％）。转诊前青蒿琥酯的可接受性较高：母亲中79.4％（95％CI 75.4-83.3），社区卫生工作者中90.3％（95％CI 82.3-96.8），以及97.8％（95％CI 93.3-100） ）。干预后坚持推荐意见[84.3％（95％CI 80.6-88。1）]不逊于干预前的依从性[94.1％（95％CI 91.7-96.4）]。结论在刚果民主共和国，将重症疟疾的转诊前青蒿琥酯转入社区护理现场是可行且可以接受的。它积极影响了对转诊建议的遵守。但是，对于5岁以下儿童的父母和社区卫生工作者，需要进行更多的健康教育。