Nonaka Daisuke, Vongseththa Kongshin, Kobayashi Jun, Bounyadeth Somboun, Kano Shigeyuki, Phompida Samlane, Jimba Masamine
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan.
Acta Trop. 2009 Dec;112(3):283-7. doi: 10.1016/j.actatropica.2009.08.013. Epub 2009 Aug 14.
This study aimed to examine the care-seeking choices for treatment of a febrile illness compatible with malaria in the public and private sectors in Lao PDR. We conducted interviews with 745 heads of household in 14 villages in the Sekong province, using a structured-questionnaire. We asked each about who the care-providers were for febrile illness episodes affecting their household members during the past year. If patients used more than one care-provider for a single episode over a period of time, we identified patterns of the care-sequences for the initial and subsequent care choices. Then, we analyzed the relationship between the initial care choices and secondary care choices for care-providers by Chi-square test, categorizing care-providers into public (hospital, health centre, and village health volunteer) and private care-providers (private pharmacy, informal retailer, faith healing and herbs). As a result, we found that 624 patients sought care at least once, 255 (40.9%) twice, and 66 (10.6%) three times or more during a single episode. Of 138 patients who started with a public care-provider and then sought a secondary care, 71 (51.4%) switched to a private care-provider. In contrast, of 117 patients who started with a private care-provider and then sought a secondary care, 82 (70.1%) switched to a public care-provider (p<0.001). In conclusion, although most patients who failed being treated by a private care-provider switched to a public one, some exclusively relied on care within the private sector. An intervention is necessary to make the private sector an integral component of malaria treatment in Lao PDR.
本研究旨在调查老挝人民民主共和国公共部门和私营部门针对与疟疾症状相符的发热疾病的就医选择情况。我们使用结构化问卷对色贡省14个村庄的745户家庭户主进行了访谈。我们询问了每户家庭在过去一年中，其家庭成员出现发热疾病时的就医提供者是谁。如果患者在一段时间内针对单次发病使用了不止一个就医提供者，我们确定了其初始和后续就医选择的就医顺序模式。然后，我们通过卡方检验分析了就医提供者的初始就医选择和二次就医选择之间的关系，将就医提供者分为公共部门（医院、卫生中心和乡村卫生志愿者）和私营部门（私人药房、非正规零售商、信仰疗法和草药）。结果发现，624名患者至少就医一次，255名（40.9%）就医两次，66名（10.6%）就医三次或更多次。在138名最初选择公共部门就医提供者然后寻求二次就医的患者中，71名（51.4%）转向了私营部门就医提供者。相比之下，在117名最初选择私营部门就医提供者然后寻求二次就医的患者中，82名（70.1%）转向了公共部门就医提供者（p<0.001）。总之，尽管大多数在私营部门就医未得到治疗的患者转向了公共部门，但一些患者完全依赖私营部门的医疗服务。有必要采取干预措施，使私营部门成为老挝人民民主共和国疟疾治疗的一个组成部分。
