van der Werf Marieke J, Bosompem Kwabena M, de Vlas Sake J
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P. O. B. 1738, 3000 DR Rotterdam, The Netherlands.
Trans R Soc Trop Med Hyg. 2003 Mar-Apr;97(2):146-52. doi: 10.1016/s0035-9203(03)90102-7.
An essential component of integrated schistosomiasis control as promoted by WHO is adequate clinical care for patients presenting at health care facilities. We evaluated the functioning of the Ghanaian health system for diagnosis and treatment of schistosomiasis by interviewing health workers from 70 health care facilities in 4 geographical areas in April and May 2000. Results from presentation of 4 hypothetical cases and a subsequent interview demonstrated that patients presenting with symptoms related to schistosomiasis have a small chance of receiving adequate treatment: often health workers do not recognize the symptoms, especially those of Schistosoma mansoni; patients are frequently referred for a diagnostic test or treatment with a large risk of non-compliance; and praziquantel was not available in 78% of the health care facilities with reported schistosomiasis in their coverage area. The overall cost of treatment is considerable: [symbol: see text] 2.13 for S. haematobium and [symbol: see text] 1.81 for S. mansoni patients, with drug costs contributing approximately 40% of the total cost. To better meet WHO recommendations for passive case detection as part of integrated schistosomiasis control, the Ghanaian health system needs to emphasize training of health workers in schistosomiasis case recognition and case management and increase the availability of praziquantel. Experience from other West African countries indicate that this is feasible.
世界卫生组织所倡导的综合性血吸虫病防治工作的一个关键组成部分，是为前往医疗机构就诊的患者提供充分的临床护理。2000年4月和5月，我们通过对4个地理区域70家医疗机构的卫生工作者进行访谈，评估了加纳卫生系统在血吸虫病诊断和治疗方面的运作情况。对4个假设病例的陈述以及随后的访谈结果表明，出现与血吸虫病相关症状的患者获得充分治疗的机会很小：卫生工作者常常无法识别这些症状，尤其是曼氏血吸虫病的症状；患者经常被转诊去做诊断检查或接受治疗，但存在很大的不依从风险；在报告其覆盖地区有血吸虫病的医疗机构中, 78%没有吡喹酮。治疗的总体成本相当可观：埃及血吸虫病患者为2.13瑞士法郎，曼氏血吸虫病患者为1.81瑞士法郎，其中药物成本约占总成本的40%。为了更好地满足世界卫生组织关于作为综合性血吸虫病防治一部分的被动病例检测的建议，加纳卫生系统需要加强对卫生工作者进行血吸虫病病例识别和病例管理方面的培训，并增加吡喹酮的可及性。其他西非国家的经验表明这是可行的。
