探索尼日利亚东南部卫生提供者和社区对疟疾检测的看法和经验：迈向适当治疗的关键一步。
Exploring health providers' and community perceptions and experiences with malaria tests in South-East Nigeria: a critical step towards appropriate treatment.
机构信息
Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria.
出版信息
Malar J. 2012 Nov 6;11:368. doi: 10.1186/1475-2875-11-368.
BACKGROUND
The adoption of ACT as the first line treatment for uncomplicated malaria in Nigeria has concentrated attention on the role of testing in appropriate malaria treatment. There are calls at both national and global level for malaria treatment to be based on test result, but it is still unclear how testing can be incorporated into treatment-seeking and practices of health providers. This study explored community members and health providers' perceptions and experiences with malaria tests in south east Nigeria.
METHODS
The study was conducted in urban and rural areas of Enugu state in south-eastern Nigeria. A total of 18 focus group discussions with 179 community members including sub-groups of primary caregivers, adult men and adult women aged 15 years and above. Twenty-six (26) In-depth interviews were held with public and private health providers involved in prescribing medicines at public and private health facilities in the study area.
RESULTS
Both providers and community members were familiar with malaria tests and identified malaria tests as an important step to distinguish malaria from other illnesses with similar symptoms and as a means of delivering appropriate treatment. However, the logic of test-directed treatment was undermined by cost of test and a lack of testing facilities but above all concerns over the reliability of negative test results, with community members and providers observing inconsistencies between results and symptoms, and providers attributing inaccurate results to incompetencies of technicians. Recognition of malaria symptoms was deemed most important in determining the use of antimalarial drugs rather than the result of a malaria test.
CONCLUSION
The results highlight important areas of intervention to promote appropriate malaria treatment. If tests are to play a role in patient management, demand and supply side interventions are needed to change people's attitude towards malaria test results.
背景
尼日利亚将 ACT 作为治疗无并发症疟疾的一线药物，这使得人们更加关注检测在适当疟疾治疗中的作用。国家和全球层面都呼吁根据检测结果进行疟疾治疗，但目前仍不清楚如何将检测纳入患者求医和卫生服务提供者的治疗实践中。本研究在尼日利亚东南部的埃努古州城乡地区，探索了社区成员和卫生服务提供者对疟疾检测的看法和经验。
方法
该研究在尼日利亚东南部埃努古州的城乡地区进行。共进行了 18 次焦点小组讨论，参与者包括初级护理人员、15 岁及以上的成年男性和成年女性亚组，共有 179 人参加；与参与在研究地区公立和私立卫生设施开具药品的公立和私立卫生提供者进行了 26 次深入访谈。
结果
提供者和社区成员都熟悉疟疾检测，并将其视为区分疟疾与其他具有相似症状的疾病以及提供适当治疗的重要步骤。然而，检测导向治疗的逻辑受到检测费用和缺乏检测设施的影响，但最重要的是对阴性检测结果的可靠性的担忧，社区成员和提供者观察到结果与症状之间的不一致，提供者将不准确的结果归因于技术人员的能力不足。确定是否使用抗疟药物主要取决于对疟疾症状的认识，而不是疟疾检测的结果。
结论
结果突出了促进适当疟疾治疗的重要干预领域。如果检测要在患者管理中发挥作用，就需要从需求和供应两方面进行干预，以改变人们对疟疾检测结果的态度。
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