van der Werf Marieke J, de Vlas Sake J, Landouré Aly, Bosompem Kwabena M, Habbema J D F
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
Trop Med Int Health. 2004 Jan;9(1):149-57. doi: 10.1046/j.1365-3156.2003.01153.x.
The World Health Organization recommends passive case detection by regular health services as a minimum strategy for schistosomiasis morbidity control. To evaluate preparedness of the health systems in Ghana and Mali, we presented four clinical scenarios, two with blood in urine (main early symptom of Schistosoma haematobium) and two with (bloody) diarrhoea (main early symptom of S. mansoni), to health workers. We requested the health personnel for an initial diagnosis and case management strategy without providing information about our primary interest in schistosomiasis. The information was used to determine the chance that a person reporting with symptoms that might have been caused by schistosomiasis would receive praziquantel. All selected health workers participated. Their initial diagnosis was frequently S. haematobium for both scenarios with blood in urine. For the two scenarios with (bloody) diarrhoea, only few mentioned S. mansoni. At health centre level, case management in Mali mainly consisted of direct prescription of medication, whereas in Ghana health workers often referred to a hospital or requested a diagnostic test. The ultimate probability of prescribing praziquantel was relatively high for the scenarios with blood in urine, 60% in Ghana and 75% in Mali, but very low for both scenarios with (bloody) diarrhoea (<20%). Of those health care facilities that would prescribe praziquantel, 60% (Ghana) and 80% (Mali) had it in stock. In conclusion, the clinical scenario study showed that patients reporting with blood in urine will be treated with praziquantel at approximately half of the health care facilities, whereas of those presenting with (bloody) diarrhoea only few would receive treatment with praziquantel. Considering these facts, it is questionable if passive case detection is a sufficient basis for effective schistosomiasis morbidity control, especially for S. mansoni infection.
世界卫生组织建议，将常规卫生服务中的被动病例检测作为控制血吸虫病发病率的最低策略。为评估加纳和马里卫生系统的准备情况，我们向卫生工作者展示了四种临床病例，其中两种有血尿（埃及血吸虫的主要早期症状），两种有（血性）腹泻（曼氏血吸虫的主要早期症状）。我们要求卫生人员进行初步诊断并制定病例管理策略，且未透露我们对血吸虫病的主要研究兴趣。这些信息用于确定报告可能由血吸虫病引起症状的人接受吡喹酮治疗的可能性。所有选定的卫生工作者都参与了。对于两种有血尿的病例，他们的初步诊断通常都是埃及血吸虫。对于两种有（血性）腹泻的病例，只有少数人提到曼氏血吸虫。在卫生中心层面，马里的病例管理主要是直接开药，而在加纳，卫生工作者经常会转诊到医院或要求进行诊断检测。对于有血尿的病例，开具吡喹酮的最终概率相对较高，在加纳为60%，在马里为75%，但对于两种有（血性）腹泻的病例，该概率非常低（<20%）。在那些会开具吡喹酮的医疗机构中，60%（加纳）和80%（马里）有该药库存。总之，临床病例研究表明，报告有血尿的患者在大约一半的医疗机构会接受吡喹酮治疗，而那些有（血性）腹泻的患者中只有少数会接受吡喹酮治疗。考虑到这些情况，被动病例检测是否足以成为有效控制血吸虫病发病率的基础，尤其是对于曼氏血吸虫感染，值得怀疑。
