Fernando Deepika, de Silva Nipun Lakshitha, Ackers Isabella, Abeyasinghe Rabindra, Wijeyaratne Pandu, Rajapakse Senaka
Department of Parasitology, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, Sri Lanka.
BMC Public Health. 2014 Jun 23;14:641. doi: 10.1186/1471-2458-14-641.
With the incidence of malaria in Sri Lanka declining, intensive parasitological surveillance has been identified as a key strategy to achieve elimination by end 2014. Tropical and Environmental Diseases and Health Associates Private Limited (TEDHA) in collaboration with the Anti-Malaria Campaign established 43 malaria diagnostic laboratories (MDL) in four post-conflict districts of the Northern and Eastern Provinces. This study assesses the patterns of referral of patients with fever for malaria diagnosis by health care providers (HCPs) in four government hospitals in one of the districts of the Northern Province, and patient satisfaction with the laboratory services offered.
In this prospective descriptive study, data was collected on the proportion of fever patients being referred by the HCP in hospitals for malaria screening, and the proportion thereof who underwent screening. An interviewer-administered questionnaire was also used to assess patient satisfaction among those attending MDL, which was graded on a scale of 0-4.
Of patients presenting to the hospitals with fever, only 44.3% were referred for malaria screening; 81.7% of them underwent screening. Referral depended largely on the presence of a permanent staff HCP. Satisfaction levels were high, with 86.55% giving an overall rating of 4. Comfort within the laboratory was rated satisfactory in three of the four hospitals.
This study demonstrates the success of a public-private partnership in the malaria control programme in Sri Lanka. Malaria is considered low on the differential diagnosis in patients with fever even in previously malaria-endemic areas, due to the declining incidence of malaria and the increase in other febrile illnesses in these areas during the recent past. Private sector run malaria diagnostic services provided free of charge within government hospitals are viable and effective, and had good patient satisfaction ratings. In a country on the brink of eliminating malaria, there should be further emphasis on ensuring that HCPs refer patients for malaria diagnosis, in order to prevent a resurgence of the disease.
随着斯里兰卡疟疾发病率的下降，强化寄生虫学监测已被确定为到2014年底实现疟疾消除的关键战略。热带与环境疾病及健康协会私人有限公司（TEDHA）与抗疟疾运动合作，在北部和东部省份的四个冲突后地区建立了43个疟疾诊断实验室（MDL）。本研究评估了北部省份一个地区的四家政府医院中，医疗服务提供者（HCP）将发热患者转诊进行疟疾诊断的模式，以及患者对所提供实验室服务的满意度。
在这项前瞻性描述性研究中，收集了医院中HCP转诊进行疟疾筛查的发热患者比例，以及接受筛查的患者比例的数据。还使用了一份由访谈员实施的问卷来评估在MDL就诊的患者的满意度，满意度按0至4分进行评分。
到医院就诊的发热患者中，只有44.3%被转诊进行疟疾筛查；其中81.7%接受了筛查。转诊很大程度上取决于是否有固定员工HCP。满意度较高，86.55%的患者给出的总体评分为4分。四家医院中有三家对实验室环境的满意度评价为满意。
本研究证明了公私伙伴关系在斯里兰卡疟疾控制项目中的成功。由于疟疾发病率下降以及近期这些地区其他发热性疾病增加，即使在以前的疟疾流行地区，疟疾在发热患者的鉴别诊断中也被认为可能性较低。在政府医院内免费提供的由私营部门运营的疟疾诊断服务是可行且有效的，并且患者满意度评分良好。在一个即将消除疟疾的国家，应进一步强调确保HCP将患者转诊进行疟疾诊断，以防止疾病再次流行。
