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医疗保健获取情况不同的亚诺马米社区中的贫血与疟疾

Anaemia and malaria in Yanomami communities with differing access to healthcare.

作者信息

Grenfell P, Fanello C I, Magris M, Goncalves J, Metzger W G, Vivas-Martínez S, Curtis C, Vivas L

机构信息

London School of Hygiene and Tropical Medicine, London, UK.

出版信息

Trans R Soc Trop Med Hyg. 2008 Jul;102(7):645-52. doi: 10.1016/j.trstmh.2008.02.021. Epub 2008 Apr 10.

Abstract

Inequitable access to healthcare has a profound impact on the health of marginalised groups that typically suffer an excess burden of infectious disease morbidity and mortality. The Yanomami are traditionally semi-nomadic people living in widely dispersed communities in Amazonian Venezuela and Brazil. Only communities living in the vicinity of a health post have relatively constant access to healthcare. To monitor the improvement in the development of Yanomami healthcare a cross-sectional survey of 183 individuals was conducted to investigate malaria and anaemia prevalence in communities with constant and intermittent access to healthcare. Demographic and clinical data were collected. Malaria was diagnosed by microscopy and haemoglobin concentration by HemoCue. Prevalence of malaria, anaemia, splenomegaly, fever and diarrhoea were all significantly higher in communities with intermittent access to healthcare (anaemia 80.8% vs. 53.6%, P<0.001; malaria 18.2% vs. 6.0%, P=0.013; splenomegaly 85.4% vs.12.5%, P<0.001; fever 50.5% vs. 28.6%, P=0.003; diarrhoea 30.3% vs.10.7% P=0.001). Haemoglobin level (10.0 g/dl vs. 11.5 g/dl) was significantly associated with access to healthcare when controlling for age, sex, malaria and splenomegaly (P=0.01). These findings indicate a heavy burden of anaemia in both areas and the need for interventions against anaemia and malaria, along with more frequent medical visits to remote areas.

摘要

医疗保健获取的不平等对边缘化群体的健康产生了深远影响,这些群体通常承受着传染病发病和死亡的过重负担。亚诺马米人传统上是半游牧民族,生活在委内瑞拉和巴西亚马逊地区广泛分散的社区中。只有居住在卫生站附近的社区才有相对稳定的医疗保健服务。为了监测亚诺马米人医疗保健发展的改善情况,对183人进行了横断面调查,以调查在有稳定和间歇性医疗保健服务的社区中疟疾和贫血的患病率。收集了人口统计学和临床数据。通过显微镜诊断疟疾,通过血红蛋白仪检测血红蛋白浓度。在获得间歇性医疗保健服务的社区中,疟疾、贫血、脾肿大、发热和腹泻的患病率均显著更高(贫血80.8%对53.6%,P<0.001;疟疾18.2%对6.0%,P=0.013;脾肿大85.4%对12.5%,P<0.001;发热50.5%对28.6%,P=0.003;腹泻30.3%对10.7%,P=0.001)。在控制年龄、性别、疟疾和脾肿大因素后,血红蛋白水平(10.0 g/dl对11.5 g/dl)与医疗保健服务的获取显著相关(P=0.01)。这些发现表明这两个地区贫血负担都很重,需要采取干预措施防治贫血和疟疾,同时增加对偏远地区的医疗探访频率。

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