马里南部儿童腹泻的家庭管理——引入锌治疗的影响

Home management of childhood diarrhoea in southern Mali--implications for the introduction of zinc treatment.

作者信息

Ellis Amy A, Winch Peter, Daou Zana, Gilroy Kate E, Swedberg Eric

机构信息

Johns Hopkins School of Public Health Baltimore, MD, USA.

出版信息

Soc Sci Med. 2007 Feb;64(3):701-12. doi: 10.1016/j.socscimed.2006.10.011. Epub 2006 Nov 13.

Abstract

Diarrhoea remains one of the leading killers of young children. A recent meta-analysis demonstrated that a two-week course of zinc tablets once daily significantly reduces the severity and duration of diarrhoea and mortality in young children (Bhutta et al., 2000. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: Pooled analysis of randomized controlled trials. American Journal of Clinical Nutrition, 72(6), 1516-1522). Formative research is being conducted in a number of countries to prepare for the large-scale promotion of this new treatment. In-depth and semi-structured interviews with parents, community health workers, and traditional healers were conducted to examine the household management of diarrhoea in the Sikasso region of southern Mali in preparation for the introduction of a short-course of daily zinc for childhood diarrhoea at the community level. Supporting data from a subsequent household survey are also presented. Although nearly all parents knew oral rehydration solution (ORS) could replace lost fluids, its inability to stop diarrhoea caused parents to seek antibiotics from local markets, traditional medicines or anti-malarials to cure the illness. The notion of combining multiple treatments to ensure the greatest therapeutic benefit was prevalent, and modern medicines were often administered simultaneously with traditional therapies. As parents often deem ORS insufficient and judge that an additional treatment should be combined with ORS to cure diarrhoea, the concept of joint therapy of zinc and ORS should be well accepted in the community. Mothers-in-law and fathers, who play a significant role in decisions to seek treatment for sick children, as well as traditional healers, should also be considered when designing new programs to promote zinc. Similarities with formative research conducted for a previous generation of diarrhoea control programmes are discussed.

摘要

腹泻仍然是幼儿的主要杀手之一。最近的一项荟萃分析表明,每天服用一次为期两周的锌片可显著降低幼儿腹泻的严重程度、持续时间和死亡率(布塔等人,2000年。口服锌对发展中国家儿童急性和持续性腹泻的治疗效果:随机对照试验的汇总分析。《美国临床营养学杂志》,72(6),1516 - 1522)。一些国家正在开展形成性研究,为大规模推广这种新疗法做准备。为了在马里南部锡卡索地区社区层面引入针对儿童腹泻的短期每日锌治疗方案,对家长、社区卫生工作者和传统治疗师进行了深入的半结构化访谈,以研究腹泻的家庭管理情况。还展示了随后家庭调查的支持数据。尽管几乎所有家长都知道口服补液盐(ORS)可以补充流失的体液,但它无法止泻,这导致家长从当地市场、传统药物或抗疟疾药物中寻求抗生素来治愈疾病。将多种治疗方法结合以确保最大治疗效益的观念很普遍,现代药物常常与传统疗法同时使用。由于家长通常认为ORS不够,并且判断应将额外的治疗与ORS结合以治愈腹泻,锌和ORS联合治疗的概念在社区中应该会被广泛接受。在设计推广锌的新方案时,还应考虑在为上一代腹泻控制方案开展的形成性研究中发现的相似之处,婆婆和父亲在为患病儿童寻求治疗的决策中发挥着重要作用,传统治疗师也应纳入考虑。

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