Nsagha Dickson S, Elat Jean-Bosco N, Ndong Proper Ab, Tata Peter N, Tayong Maureen-Nill N, Pokem Francois F, Wankah Christian C
Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
Drug Healthc Patient Saf. 2012;4:1-18. doi: 10.2147/DHPS.S25406. Epub 2011 Dec 29.
Over 90% of malaria cases occur in Sub-Saharan Africa, where a child under the age of 5 years dies from this illness every 30 seconds. The majority of families in Sub- Saharan Africa treat malaria at home, but therapy is often incomplete, hence the World Health Organization has adopted the strategy of home management of malaria to solve the problem. The purpose of this study was to determine community perception and the treatment response to episodes of childhood malaria in an urban setting prior to implementation of home management using artemisinin-based combination therapy (ACT).
This qualitative exploratory study on the home management of malaria in urban children under 5 years of age used 15 focus group discussions and 20 in-depth interviews in various categories of caregivers of children under 5 years. One hundred and eighteen people participated in the focus group discussions and 20 in the in-depth interviews. The study explored beliefs and knowledge about malaria, mothers' perception of home management of the disease, health-seeking behavior, prepackaged treatment of malaria using ACT and a rapid diagnostic test, preferred channels for home management of uncomplicated malaria, communication, the role of the community in home management of malaria, and the motivation of drug distributors in the community.
The mothers' perception of malaria was the outcome of events other than mosquito bites. Home treatment is very common and is guided by the way mothers perceive signs and symptoms of malaria. Frequent change of malarial drugs by the national health policy and financial difficulties were the main problems mothers faced in treating febrile children. Rapid diagnostic testing and prepackaged ACT for simple malaria in children under 5 years would be accepted if it was offered at an affordable price. Tribalism and religious beliefs might hinder the delivery of home management of malaria. The availability of rapid diagnostic testing and ACT all year round is one of the challenges of home management of malaria. Although radio and television featured among the current sources of information within the community, meetings, churches, schools, and other public gatherings were the best venues for social mobilization, while community health workers and community leaders were the best sensitization agents for positive behavior change to adhere to home management of malaria. Monetary incentives should be offered to community drug distributors. This should be deducted from the combined price of ACT and rapid diagnostic testing.
For successful implementation of home management of malaria, there should be proper education, social mobilization of the population, and continuous monitoring and evaluation of field activities to ensure adequate stocks of ACT and rapid diagnostic testing within the framework of the intervention.
超过90%的疟疾病例发生在撒哈拉以南非洲，每30秒就有一名5岁以下儿童死于这种疾病。撒哈拉以南非洲的大多数家庭在家中治疗疟疾，但治疗往往不彻底，因此世界卫生组织采用了疟疾家庭管理策略来解决这一问题。本研究的目的是在使用青蒿素联合疗法（ACT）实施家庭管理之前，确定城市环境中社区对儿童疟疾发作的认知以及治疗反应。
这项关于5岁以下城市儿童疟疾家庭管理的定性探索性研究，采用了15次焦点小组讨论和20次对5岁以下儿童各类照料者的深入访谈。118人参加了焦点小组讨论，20人参加了深入访谈。该研究探讨了关于疟疾的信念和知识、母亲对该疾病家庭管理的认知、就医行为、使用ACT和快速诊断检测进行疟疾预包装治疗、单纯性疟疾家庭管理的首选途径、沟通、社区在疟疾家庭管理中的作用以及社区药品经销商的积极性。
母亲们认为疟疾是蚊虫叮咬以外的其他事件导致的结果。家庭治疗非常普遍，且受母亲对疟疾症状和体征的认知方式所引导。国家卫生政策导致抗疟药物频繁更换以及经济困难是母亲们在治疗发热儿童时面临的主要问题。如果以可承受的价格提供，5岁以下儿童单纯性疟疾的快速诊断检测和预包装ACT会被接受。部落主义和宗教信仰可能会阻碍疟疾家庭管理的实施。全年都能获得快速诊断检测和ACT是疟疾家庭管理面临的挑战之一。尽管广播和电视是社区当前的信息来源之一，但会议、教堂、学校和其他公共集会是社会动员的最佳场所，而社区卫生工作者和社区领袖是促使积极行为改变以坚持疟疾家庭管理的最佳宣传者。应该向社区药品经销商提供金钱激励。这应从ACT和快速诊断检测的总价中扣除。
为了成功实施疟疾家庭管理，应该进行适当的教育、对民众进行社会动员，并对实地活动进行持续监测和评估，以确保在干预框架内有足够的ACT和快速诊断检测库存。
