Danso-Appiah A, De Vlas S J, Bosompem K M, Habbema J D F
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Trop Med Int Health. 2004 Jul;9(7):784-94. doi: 10.1111/j.1365-3156.2004.01267.x.
Morbidity control of schistosomiasis through integration within existing health care delivery systems is considered a potentially sustainable and cost-effective approach. We conducted a questionnaire-based field study in a Ghanaian village endemic for both urinary and intestinal schistosomiasis to determine whether infected individuals self-reported to health centres or clinics and to identify factors that influenced their decision to seek health care. A total of 317 subjects were interviewed about having signs and symptoms suggestive of schistosomiasis: blood in urine, painful urination, blood in stool/bloody diarrhoea, abdominal pain, diarrhoea, swollen abdomen and fatigue within 1 month of the day of the interview. Fever (for malaria) was included as a disease of high debility for comparison. Around 70% with blood in urine or painful urination did not seek health care, whilst diarrhoea, blood in stool, abdominal pain and fever usually led to action (mainly self-medication, with allopathic drugs being used four to five times more often than herbal treatment). On average 20% of schistosomiasis-related signs and symptoms were reported to health facilities either as the first option or second and third alternative by some of those that self-medicated. A few of those who visited a clinic or health centre as first option still self-medicated afterwards. Children under 10 years and adults were more likely to seek health care than teenagers. Also, females were more likely to visit a health facility than males of the same age groups. Socio-economic status and duration of symptoms did not appear to affect health-seeking behaviour. 'Do not have the money' (43%) and 'Not serious enough' (41%) were the commonest reasons for not visiting a clinic, reported more frequently by lower and higher socio-economic classes, respectively, for both urinary or intestinal schistosomiasis. The regular health service shows some potential in passive control of schistosomiasis as some, but far too few, people visit a health facility as first or second option.
通过整合到现有的卫生保健服务体系中来控制血吸虫病的发病率，被认为是一种具有潜在可持续性和成本效益的方法。我们在加纳一个同时流行泌尿和肠道血吸虫病的村庄开展了一项基于问卷调查的实地研究，以确定受感染个体是否会主动前往卫生中心或诊所就诊，并找出影响他们寻求医疗保健决策的因素。总共对317名受试者进行了访谈，询问他们在访谈当天前1个月内是否有提示血吸虫病的体征和症状：血尿、排尿疼痛、便血/血性腹泻、腹痛、腹泻、腹部肿胀和疲劳。发热（针对疟疾）作为一种高衰弱性疾病被纳入以作比较。约70%有血尿或排尿疼痛症状的人未寻求医疗保健，而腹泻、便血、腹痛和发热通常会促使人们采取行动（主要是自我用药，使用对抗疗法药物的频率比草药治疗高出四到五倍）。平均而言，一些自我用药的人将20%与血吸虫病相关的体征和症状作为首选或第二、第三选择报告给了卫生机构。少数作为首选前往诊所或卫生中心就诊的人之后仍会自我用药。10岁以下儿童和成年人比青少年更有可能寻求医疗保健。此外，在同一年龄组中，女性比男性更有可能前往卫生机构就诊。社会经济地位和症状持续时间似乎并未影响就医行为。“没钱”（43%）和“病情不够严重 ”（41%）是未去诊所就诊的最常见原因，在泌尿或肠道血吸虫病患者中，社会经济地位较低和较高的阶层分别更频繁地报告了这两个原因。常规卫生服务在血吸虫病的被动控制方面显示出一些潜力，因为一些人（但数量太少）将前往卫生机构作为首选或第二选择。
