Quantitative G6PD Deficiency Screening in Routine Malaria Diagnostic Units in the Brazilian Amazon (SAFEPRIM): An Operational Mixed-Methods Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Study Sites
2.3. HCPs Training and Proficiency Assessment
2.4. G6PD Testing, Results Recording and Pharmacovigilance of Hemolysis
2.5. Genotyping of A Subset of Samples
2.6. Quality Assurance and Oversight
2.7. Perceptions of HCPs and Patients about Implementation
2.8. Data Collection
2.9. Qualitative Data Analysis
2.10. Statistical Analysis
2.11. Ethical Clearance
3. Results
3.1. Study Population, G6PD Distribution and Treatment
3.2. Confirmatory G6PD Genotyping
3.3. Training and Reliability of Interpretation
“The training was very good, we practiced too. What stuck most in my mind was the treatment, because many people were in doubt about which medication would be used if the person could not take the medications daily. There were many people with doubts when the G6PD value was below four…”(HCP001_081720)
3.4. Perceptions about Test Usage
“I don’t understand why this test is done. It was exactly with this doubt that I left the training…”(HCP014_082020)
“On the day of training I had no difficulty handling it, but I’ll be honest, if you asked me to do it now I wouldn’t know how, because I did the training but I didn’t practice in the field. So for me it’s difficult.”(HCP001_081720)
“The test is for finding people who have a reaction with chloroquine, not primaquine.”(HCP012_082020)
3.5. Malaria Card and G6PD Result Recording
“It’s important because it’s like proof that I had malaria, I can get to someone and show that I had malaria, it’s like a document I think. That’s why I consider it important because even for me to travel, if I arrive at a place and there is a police barrier, I can show that I already had (malaria) and had the treatment and I can travel. My card is kept in my wallet, I always carry it, when I travel I like to carry my documents. I think it’s necessary to always show the card to prove that it has already happened. If I lose my card, it’s difficult for me to prove that I had malaria.”(patient09_082020)
3.6. Perceptions about Acute Hemolytic Anemia
“Anemia is when the person has weakness in the legs, lack of blood. That’s anemia. I don’t think it’s related to primaquine… but I can’t explain why not.”(HCP014_082020)
“Hemolytic anemia, I think it’s a serious anemia, I think it’s due to having several malarias, and not because of the medicine.”(HCP016_082020)
“With the first doses patients always feel very ill, with dizziness, weakness, fainting. I’ve seen reports of yellowish eyes, dark urine, but that was with the first three doses of the medicine, they got better afterwards.”(HCP013_082020)
“In the case of patients who use the weekly treatment, they always report that they understand now why the urine was dark before, but now there are some patients who do not accept it, they say it will not cure, they think it is too much medicine and it has already happened that they abandoned treatment.”(HCP010_081820)
“Patients prefer the seven-day treatment, especially those who like alcoholic drinks. Sometimes, mothers of young children don’t like the weekly treatment.”(FGD001_081720)
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Rio Preto da Eva n = 413 | Mâncio Lima n = 1241 |
---|---|---|
Females, n (%) | 159/413 (38.5%) | 497/1241 (40.0%) |
Males, n (%) | 254/413 (61.5%) | 744/1241 (60.0%) |
Median age (SD) | 32.3 (18.7%) | 24.6 (17.2%) |
G6PD Activity Ranges | ||
<4.0 IU/gHb (M/F) | 15/8 | 24/16 |
≥4.0 and ≤6.0 IU/gHb (M/F) | 16/10 | 63/59 |
>6.0 (M/F) | 56/36 | 505/298 |
Radical Cure Treatments | ||
Study participants prescribed 7-day primaquine | 126/150 (84.0%) | 1104/1208 (91.4%) |
Study participants prescribed weekly dose primaquine | 22/150 (14.7%) | 34/1208 (2.8%) |
Other | 2/150 (1.3%) | 70/1208 (5.8%) |
Males (n = 81) | Females (n = 59) | ||||
STANDARDTM G6PD Test Result | Hemizygous Deficient | Hemizygous Normal | Homozygous Deficient | Heterozygous | Homozygous Normal |
<4.0 U/gHb | 18 | 10 | - | 3 | 13 |
≥4.0 and ≤6.0 U/gHb | - | 15 | - | - | 8 |
>6.0 U/gHb | - | 38 | - | - | 35 |
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Brito-Sousa, J.D.; Murta, F.; Vitor-Silva, S.; Sampaio, V.; Mendes, M.; Souza, B.; Batista, T.; Santos, A.; Marques, L.; Barbosa, L.; et al. Quantitative G6PD Deficiency Screening in Routine Malaria Diagnostic Units in the Brazilian Amazon (SAFEPRIM): An Operational Mixed-Methods Study. Pathogens 2022, 11, 1328. https://doi.org/10.3390/pathogens11111328
Brito-Sousa JD, Murta F, Vitor-Silva S, Sampaio V, Mendes M, Souza B, Batista T, Santos A, Marques L, Barbosa L, et al. Quantitative G6PD Deficiency Screening in Routine Malaria Diagnostic Units in the Brazilian Amazon (SAFEPRIM): An Operational Mixed-Methods Study. Pathogens. 2022; 11(11):1328. https://doi.org/10.3390/pathogens11111328
Chicago/Turabian StyleBrito-Sousa, Jose Diego, Felipe Murta, Sheila Vitor-Silva, Vanderson Sampaio, Maxwell Mendes, Brenda Souza, Talita Batista, Alicia Santos, Leonardo Marques, Laila Barbosa, and et al. 2022. "Quantitative G6PD Deficiency Screening in Routine Malaria Diagnostic Units in the Brazilian Amazon (SAFEPRIM): An Operational Mixed-Methods Study" Pathogens 11, no. 11: 1328. https://doi.org/10.3390/pathogens11111328