Mouyokani J, Tursz A, Crost M, Cook J, Nzingoula S
Département de Santé Publique, Faculté des Sciences de la Santé, Brazzaville, Congo.
Rev Epidemiol Sante Publique. 1999 Oct;47 Suppl 2:2S115-31.
In most of the large cities in developing countries, geographic accessibility to health care is not a major problem. Thus, indifference to public services and a preference for home treatment, recourse to traditional medicine or to the private sector may be related to problems in the quality of services. A cross-sectional epidemiological study of hospital visits by under-5 children was carried out in health centres and hospital out-patient services in Brazzaville (Congo). Sampling in these health facilities was done using a systematic random sample with a proportion of 25%, during 4 periods chosen according to seasonal factors. An exhaustive investigation of the entire public sector serving children was done in the study. At the same time, the same data were gathered in a sample of private facilities (doctors' and nurses' offices, traditional healers, religious healing centres), chosen as a function of their permanence and the numbers of their clientele. This article analyses services offered during 2215 visits by children, who were under 1 year of age in more than 50% of cases. In the public sector, 75% of visits were to first-line health centres. Public services show marked dysfunctions: the complexity of internal referrals, clinical examinations which are inadequate in relation to symptoms, and poor communication (explanations as to cause of illness in less than 2% of cases, and on treatments in less than 50% of cases). Communication seems well developed among private physicians and traditional healers, the latter engaging in both preventive and curative activities. Communication during well-child visits and consultations at health centres is especially disappointing, in light of the very young age of the parents (1/4 are high-school or college students). There is a two-fold risk in this situation: flight towards non-conventional medicine on the one hand, and access to private medicine based on socio-economic status on the other. It thus appears necessary to standardise procedures and acts in first line public health services and to promote training of personnel in communication skills with families (training using social science perspectives and participative pedagogical techniques).
在发展中国家的大多数大城市，获得医疗保健服务的地理便利性并非主要问题。因此，对公共服务的冷漠以及对家庭治疗、求助于传统医学或私营部门的偏好，可能与服务质量问题有关。在布拉柴维尔（刚果）的卫生中心和医院门诊服务机构，针对5岁以下儿童的医院就诊情况开展了一项横断面流行病学研究。在这些卫生设施中抽样采用系统随机抽样，抽样比例为25%，在根据季节因素选定的4个时间段内进行。该研究对为儿童服务的整个公共部门进行了详尽调查。与此同时，在一些私营机构（医生和护士诊所、传统治疗师、宗教治疗中心）的样本中收集了相同的数据，这些私营机构是根据其稳定性和客户数量选定的。本文分析了2215例儿童就诊期间所提供的服务，其中超过50%的儿童年龄在1岁以下。在公共部门，75%的就诊是在一线卫生中心。公共服务存在明显功能失调：内部转诊复杂，临床检查与症状不匹配，沟通不畅（不到2%的病例对病因进行了解释，不到50%的病例对治疗方法进行了解释）。私营医生和传统治疗师之间的沟通似乎较为良好，后者同时开展预防和治疗活动。鉴于家长非常年轻（四分之一是高中生或大学生），在健康儿童就诊和卫生中心咨询期间的沟通尤其令人失望。在这种情况下存在双重风险：一方面转向非传统医学，另一方面根据社会经济地位选择私营医疗服务。因此，似乎有必要规范一线公共卫生服务的程序和行为，并促进对工作人员进行与家庭沟通技巧的培训（采用社会科学视角和参与式教学技术进行培训）。
