Pacific Malaria Initiative Support Centre, School of Population Health, University of Queensland, (Herston Road), Brisbane, (4006), Australia.
Malar J. 2011 Jul 26;10:204. doi: 10.1186/1475-2875-10-204.
Early diagnosis and prompt effective case management are important components of any malaria elimination strategy. Tafea Province, Vanuatu has a rich history of traditional practices and beliefs, which have been integrated with missionary efforts and the introduction of modern constructions of health. Gaining a detailed knowledge of community perceptions of malarial symptomatology and treatment-seeking behaviours is essential in guiding effective community participation strategies for malaria control and elimination.
An ethnographic study involving nine focus group discussions (FGD), 12 key informant interviews (KII) and seven participatory workshops were carried out on Tanna Island, Vanuatu. Villages in areas of high and low malaria transmission risk were selected. Four ni-Vanuatu research officers, including two from Tanna, were trained and employed to conduct the research. Data underwent thematic analysis to examine treatment-seeking behaviour and community perceptions of malaria.
Malaria was perceived to be a serious, but relatively new condition, and in most communities, identified as being apparent only after independence in 1980. Severe fever in the presence of other key symptoms triggered a diagnosis of malaria by individuals. Use of traditional or home practices was common: perceived vulnerability of patient and previous experience with malaria impacted on the time taken to seek treatment at a health facility. Barriers to health care access and reasons for delay in care-seeking included the availability of health worker and poor community infrastructure.
Due to programme success of achieving low malaria transmission, Tafea province has been identified for elimination of malaria by 2012 in the Government of Vanuatu Malaria Action Plans (MAP). An effective malaria elimination programme requires interactions between the community and its leaders, malaria workers and health providers for success in diagnosis and prompt treatment. As malaria becomes more uncommon, utilizing unique motivators for communities to seek early diagnosis and treatment is important, particularly as other health conditions that cause fevers become increasingly more common. The design of these interventions are dependent upon robust understanding of community perceptions of disease, and the evolving nature of these perceptions.
早期诊断和及时有效的病例管理是任何消除疟疾策略的重要组成部分。瓦努阿图塔菲亚省拥有丰富的传统习俗和信仰历史，这些习俗和信仰与传教士的努力以及现代健康观念的引入相结合。深入了解社区对疟疾症状和治疗方法的认知，对于指导有效的社区参与疟疾控制和消除策略至关重要。
在瓦努阿图塔纳岛进行了一项民族志研究，包括九次焦点小组讨论（FGD）、十二次关键知情人访谈（KII）和七次参与式研讨会。选择了疟疾高传播风险和低传播风险地区的村庄。四名瓦努阿图研究人员，包括两名来自塔纳的人员，接受了培训并被雇用进行研究。对数据进行了主题分析，以检查治疗方法和社区对疟疾的认知。
疟疾被认为是一种严重但相对较新的疾病，在大多数社区中，只有在 1980 年独立后才被发现。个体在出现其他关键症状时出现严重发热，会被诊断为疟疾。传统或家庭疗法的使用很常见：患者的脆弱性和以前的疟疾经验会影响到他们前往医疗机构就诊的时间。获得医疗保健的障碍和延迟就医的原因包括卫生工作者的可用性和社区基础设施的不足。
由于计划成功实现了低疟疾传播，瓦努阿图政府已将塔菲亚省确定为 2012 年消除疟疾的目标。有效的疟疾消除计划需要社区及其领导人、疟疾工作者和卫生提供者之间的互动，以确保及时诊断和治疗。随着疟疾变得越来越罕见，利用独特的激励因素让社区尽早寻求诊断和治疗非常重要，尤其是因为其他引起发热的健康问题变得越来越常见。这些干预措施的设计取决于对社区对疾病的认知和这些认知的变化的深入理解。
