Onwujekwe O, Ojukwu J, Uzochukwu B, Dike N, Ikeme A, Shu E
Gates Malaria Partnership, London School of Hygiene and Tropical Medicine, UK.
Ann Trop Med Parasitol. 2005 Jul;99(5):473-81. doi: 10.1179/136485905X51283.
The relationship between the socio-economic status (SES) of a household and its sources of malaria diagnosis and treatment was explored in south-eastern Nigeria. One aim was to see if, as seems likely, the poorest people generally seek care from 'low-level' providers, such as traditional healers and community-based healthworkers, because of their severe budget constraints. Interviewer-administered questionnaires were used to collect information from 1197 randomly selected respondents from four villages where malaria is holo-endemic. An index was used to categorize the study households into SES quartiles. The self-diagnosis of presumptive malaria and the use of patent-medicine dealers for treatment were very common among all the SES groupings. Compared with the other interviewees, however, the least-poor were significantly more likely to rely on laboratory tests for diagnosis and to visit hospitals when seeking treatment for presumptive malaria. The most-poor, in contrast, were significantly more likely to seek treatment from traditional healers or community-based healthworkers. Thus, even though the use of low-level providers was so common, there was still evidence of wealth-related inequity--in terms of the probabilities of the good diagnosis and treatment of malaria. Improvements in the quality of malaria diagnosis and treatment by the providers patronised by the most-poor villagers would help to redress this inequity, at least in the short- to medium-term.
在尼日利亚东南部，对家庭社会经济地位（SES）与其疟疾诊断和治疗来源之间的关系进行了探究。一个目的是了解，正如看起来很有可能的那样，最贫困的人群是否由于预算严重受限，通常会向“低水平”的医疗服务提供者寻求治疗，比如传统治疗师和社区卫生工作者。通过访谈员管理的问卷，从四个疟疾高度流行的村庄中随机抽取的1197名受访者那里收集信息。使用一个指数将研究家庭划分为社会经济地位四分位数。在所有社会经济地位分组中，自我诊断疑似疟疾以及使用成药经销商进行治疗的情况都非常普遍。然而，与其他受访者相比，最不贫困的人群在诊断时显著更倾向于依赖实验室检测，在寻求疑似疟疾治疗时显著更倾向于前往医院。相反，最贫困的人群显著更倾向于向传统治疗师或社区卫生工作者寻求治疗。因此，尽管使用低水平医疗服务提供者的情况很常见，但在疟疾的良好诊断和治疗概率方面，仍存在与财富相关的不公平现象。至少在短期到中期内，改善最贫困村民所光顾的医疗服务提供者的疟疾诊断和治疗质量，将有助于纠正这种不公平现象。
