坦桑尼亚致命疟疾的就医模式。
Care-seeking patterns for fatal malaria in Tanzania.
作者信息
de Savigny Don, Mayombana Charles, Mwageni Eleuther, Masanja Honorati, Minhaj Abdulatif, Mkilindi Yahya, Mbuya Conrad, Kasale Harun, Reid Graham
机构信息
Tanzania Essential Health Interventions Project, P.O. Box 78487, Dar es Salaam, Tanzania.
出版信息
Malar J. 2004 Jul 28;3:27. doi: 10.1186/1475-2875-3-27.
BACKGROUND
Once malaria occurs, deaths can be prevented by prompt treatment with relatively affordable and efficacious drugs. Yet this goal is elusive in Africa. The paradox of a continuing but easily preventable cause of high mortality raises important questions for policy makers concerning care-seeking and access to health systems. Although patterns of care-seeking during uncomplicated malaria episodes are well known, studies in cases of fatal malaria are rare. Care-seeking behaviours may differ between these groups.
METHODS
This study documents care-seeking events in 320 children less than five years of age with fatal malaria seen between 1999 and 2001 during over 240,000 person-years of follow-up in a stable perennial malaria transmission setting in southern Tanzania. Accounts of care-seeking recorded in verbal autopsy histories were analysed to determine providers attended and the sequence of choices made as the patients' condition deteriorated.
RESULTS
As first resort to care, 78.7% of malaria-attributable deaths used modern biomedical care in the form of antimalarial pharmaceuticals from shops or government or non-governmental heath facilities, 9.4% used initial traditional care at home or from traditional practitioners and 11.9% sought no care of any kind. There were no differences in patterns of choice by sex of the child, sex of the head of the household, socioeconomic status of the household or presence or absence of convulsions. In malaria deaths of all ages who sought care more than once, modern care was included in the first or second resort to care in 90.0% and 99.4% with and without convulsions respectively.
CONCLUSIONS
In this study of fatal malaria in southern Tanzania, biomedical care is the preferred choice of an overwhelming majority of suspected malaria cases, even those complicated by convulsions. Traditional care is no longer a significant delaying factor. To reduce mortality further will require greater emphasis on recognizing danger signs at home, prompter care-seeking, improved quality of care at health facilities and better adherence to treatment.
背景
一旦感染疟疾，使用相对廉价且有效的药物进行及时治疗可预防死亡。然而，这一目标在非洲却难以实现。持续存在但又易于预防的高死亡率病因这一矛盾现象，给政策制定者提出了有关寻求医疗服务和获取卫生系统资源的重要问题。尽管非重症疟疾发作期间的就医模式已为人熟知，但关于致命性疟疾病例的研究却很少。这两类人群的就医行为可能存在差异。
方法
本研究记录了1999年至2001年期间在坦桑尼亚南部一个疟疾常年稳定传播地区，24万多人年随访中出现的320例5岁以下致命性疟疾儿童的就医情况。分析口头尸检记录中记载的就医情况，以确定就诊的医疗服务提供者以及随着患者病情恶化所做出的选择顺序。
结果
作为首选的就医方式，78.7%的疟疾所致死亡病例采用了现代生物医学治疗，即从商店、政府或非政府卫生机构获取抗疟药物；9.4%的病例最初在家中或由传统行医者提供传统治疗；11.9%的病例未寻求任何治疗。儿童性别、户主性别、家庭社会经济地位或是否出现惊厥等因素对选择模式均无影响。在所有年龄且不止一次寻求治疗的疟疾死亡病例中，无论有无惊厥，现代治疗分别在首次或第二次就医选择中占90.0%和99.4%。
结论
在这项关于坦桑尼亚南部致命性疟疾的研究中，生物医学治疗是绝大多数疑似疟疾病例的首选，即使是那些伴有惊厥的病例。传统治疗不再是一个重要的延误因素。要进一步降低死亡率，需要更加重视在家中识别危险信号、更及时地寻求治疗、提高卫生机构的医疗质量以及更好地坚持治疗。
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