Faye O, Hay R J, Ryan T J, Keita S, Traoré A K, Mahé A
CNAM-Ex Institut Marchoux, BP 251, Bamako, Mali.
Lepr Rev. 2007 Mar;78(1):11-6.
In countries where leprosy control is integrated to general heath services, health workers, at primary health care level, often manage a large number of patients with skin diseases including leprosy. The distinction of leprosy from others skin diseases requires more skill and attention. Basic dermatological knowledge will help these staff to provide a better quality of care. A few years ago, a short term training programme focussed on leprosy and some common skin diseases was set up in Mali through a pilot project. This study will evaluate the impact of this training on the detection of leprosy at primary health care level.
health care workers from two health districts were invited to participate in the training. Trainee was submitted to an anonymous written test before training, immediately after and 12-18 months post-training using a standardized scoring system. The suspected or referred leprosy cases before and after training were compared. Data were recorded and analysed with the software Epi info version 6.04.
Overall, 495 HCW attended the three anonymous written tests (before training, just after and 12-18 months later). The proportion of participants who gave correct answers before training, just after were respectively: 33 and 57% for correct diagnosis, 5 and 39% for test of sensation and 28 and 47% for referral. Eight patients suspected of leprosy were referred for further examination; in these, five cases of leprosy were detected.
The training showed a huge improvement in the skill of the participants in managing leprosy patients. This study addresses how leprosy control can be improved by involving primary health care staff and by the implementation of only a single day's training on basic dermatology.
The role of the dermatologist in this post-elimination era of leprosy needs to be reconsidered and adapted to the increasing need to take multiple programmes, inclusive of dermatology and leprosy, into primary health care services and those interested in leprosy control should fund these programmes.
在麻风病防治工作与一般卫生服务相结合的国家，基层医疗卫生人员常常要诊治大量包括麻风病在内的皮肤病患者。区分麻风病与其他皮肤病需要更多的技能和关注。基础皮肤病学知识将有助于这些工作人员提供更高质量的护理。几年前，通过一个试点项目在马里设立了一个针对麻风病和一些常见皮肤病的短期培训项目。本研究将评估该培训对基层医疗卫生机构麻风病检测的影响。
邀请来自两个卫生区的医护人员参加培训。培训前、培训刚结束后以及培训后12 - 18个月，让学员参加一个使用标准化评分系统的匿名笔试。比较培训前后疑似或转诊的麻风病病例。使用Epi info 6.04软件记录和分析数据。
总体而言，495名医护人员参加了这三次匿名笔试（培训前、培训刚结束后以及12 - 18个月后）。培训前、培训刚结束后给出正确答案的参与者比例分别为：正确诊断方面为33%和57%，感觉测试方面为5%和39%，转诊方面为28%和47%。有8名疑似麻风病患者被转诊作进一步检查；其中检测出5例麻风病病例。
培训显示参与者在管理麻风病患者的技能方面有了巨大提升。本研究探讨了如何通过让基层医疗卫生人员参与以及实施仅一天的基础皮肤病学培训来改善麻风病防治工作。
在麻风病消除后的这个时代，皮肤科医生的作用需要重新审视，并应适应将包括皮肤病学和麻风病防治在内的多个项目纳入基层医疗卫生服务的日益增长的需求，而且对麻风病防治感兴趣的各方应资助这些项目。
