Oryema-Lalobo Michael
Makerere University, School of Public Health, Kampala, Uganda.
East Afr J Public Health. 2009 Aug;6(2):191-6. doi: 10.4314/eajph.v6i2.51768.
To obtain baseline information on health seeking practice of communities in management of the under-5 malaria fever that would indicate the outcome of introducing home management.
A cross-sectional study conducted in Bugiri District interviewing 451 heads of households at random throughout the district of, 411,250 population using structured and open questionnaires on health seeking practice in the management of malaria of under-5 in the communities.
20.2% of the communities took prompt action to treat children, although 51.7% consulted health workers (HW). Sources of treatment were drug shops (48.1%), and health units (42.4%), and very few herbalists. Few cases (7.8%) were referred to higher level. In the health units HW treated 65.7% of ill children with anti-malarial. At home caretakers gave anti-malarial to only 39.4%. Were communities to follow WHO diagnosis guidelines in home management, caretakers would treat 95.6% of illnesses with anti-malarial; an excess of 29.9% over HW. Large proportions (56.4%) of caretakers gave anti-malarial for treating any fever. 36.8% recognized Chloroquine as anti-malarial. Correct Chloroquine dose was used in 6.7%. Nearest health unit was within 2-3 km radius accessible on foot. Cost of management was affordable at Ugx 1,000/=. Referral units were far (25 km).
Malaria is under-diagnosed, late and wrongly treated, with few referrals to higher levels. Home-based management will reduce morbidity and save more lives of malaria in under-5 but it will be like a mass treatment of children under-five in Bugiri District with the consequence of rapid introduction of drug resistance of the parasite, hence the need to improve on diagnosis to reduce unnecessary drug use.
获取社区在5岁以下儿童疟疾发热管理方面的就医行为基线信息，以表明引入家庭管理的效果。
在布吉里区进行了一项横断面研究，使用结构化和开放式问卷，随机采访了该地区411250人口中的451户家庭户主，了解社区中5岁以下儿童疟疾管理方面的就医行为。
20.2%的社区会迅速采取行动治疗儿童，尽管51.7%的家长会咨询卫生工作者。治疗来源为药店（48.1%）和卫生单位（42.4%），很少找草药医生。很少有病例（7.8%）被转诊到上级机构。在卫生单位，卫生工作者用抗疟药治疗了65.7%的患病儿童。在家中，照顾者仅给39.4%的儿童服用了抗疟药。如果社区遵循世界卫生组织在家中管理的诊断指南，照顾者将用抗疟药治疗95.6%的疾病；比卫生工作者多29.9%。很大比例（56.4%）的照顾者给孩子服用抗疟药来治疗任何发热症状。36.8%的人认识到氯喹是抗疟药。正确使用氯喹剂量的占6.7%。最近的卫生单位在步行2至3公里半径范围内。管理费用可承受，为乌干达先令1000/=。转诊单位距离较远（25公里）。
疟疾诊断不足、治疗不及时且错误，很少转诊到上级机构。家庭管理将降低5岁以下儿童疟疾的发病率并挽救更多生命，但这将类似于对布吉里区5岁以下儿童进行大规模治疗，结果会导致寄生虫迅速产生耐药性，因此需要改进诊断以减少不必要的药物使用。
