Mahé A, Faye O, N'Diaye H Thiam, Ly F, Konaré H, Kéita S, Traoré A K, Hay R
Institut d'Hygiène Sociale, B.P. 7045, Dakar-Fann, Senegal.
Trans R Soc Trop Med Hyg. 2005 Jan;99(1):39-47. doi: 10.1016/j.trstmh.2004.03.008.
In order to help primary health care (PHC) workers in developing countries in the care of common skin diseases, an algorithm for the management of pyoderma, scabies, superficial mycoses, contact dermatitis and referral of early leprosy cases (based on the identification of diseases through the presence of objective key signs, and on treatments by generic drugs) was elaborated. One thousand patients were seen by trained dermatologists, who established diagnoses and treatments; in addition, there was systematic recording of each key sign, according to the successive algorithm steps. We compared the diagnostics and treatments obtained for several combinations of diagnostic signs, with those of the dermatologists. Sensitivity, specificity, positive predictive value and negative predictive value of defined combinations were high for pyoderma, scabies and superficial mycoses. Values were less exact for dermatitis and leprosy, but were considered sufficient for the level of health care targeted. The apportionment of treatments between the algorithm and the dermatological approaches was considered appropriate in more than 80% of cases; mismanagement was possible in 7% of cases, with few predictable harmful consequences. The algorithm was found satisfactory for the management of the dermatological priorities according to the standards required at the PHC level.
为帮助发展中国家的初级卫生保健（PHC）工作者护理常见皮肤病，制定了一种脓疱病、疥疮、浅表真菌病、接触性皮炎及早期麻风病例转诊（基于通过客观关键体征识别疾病以及使用通用药物治疗）的管理算法。由经过培训的皮肤科医生诊治了1000名患者，他们确定诊断和治疗方法；此外，还根据算法的连续步骤系统记录每个关键体征。我们将通过诊断体征的几种组合得出的诊断和治疗方法与皮肤科医生的诊断和治疗方法进行了比较。对于脓疱病、疥疮和浅表真菌病，特定组合的敏感性、特异性、阳性预测值和阴性预测值都很高。对于皮炎和麻风病，这些值不太精确，但对于目标卫生保健水平而言被认为足够。在超过80%的病例中，算法和皮肤科方法之间的治疗分配被认为是合适的；7%的病例可能存在管理不当，但可预测的有害后果很少。根据初级卫生保健层面所需标准，该算法被认为在管理皮肤病重点方面令人满意。
