Kisoka William J, Tersbøl Britt Pinkowsky, Meyrowitsch Dan W, Simonsen Paul E, Mushi Declare L
*National Institute for Medical Research,Dar es Salaam,Tanzania.
‡Global Health Section, Department of Public Health,University of Copenhagen,Denmark.
J Biosoc Sci. 2016 Jan;48(1):94-112. doi: 10.1017/S0021932015000024. Epub 2015 Mar 19.
Lymphatic filariasis is one of several neglected tropical diseases with severely disabling and stigmatizing manifestations that are referred to as 'neglected diseases of poverty'. It is a mosquito-borne disease found endemically and exclusively in low-income contexts where, concomitantly, general public health care is often deeply troubled and fails to meet the basic health needs of impoverished populations. This presents particular challenges for the implementation of mass drug administration (MDA), which currently is the principal means of control and eventual elimination. Several MDA programmes face the dilemma that they are unable to attain and maintain the required drug coverage across target groups. In recognition of this, a qualitative study was conducted in the Morogoro and Lindi regions of Tanzania to gain an understanding of community experiences with, and perceptions of, the MDA campaign implemented in 2011 by the National Lymphatic Filariasis Elimination Programme. The study revealed a wide variation of perceptions and experiences regarding the aim, rationale and justification of MDA. There were positive sentiments about the usefulness of the drugs, but many study participants were sceptical about the manner in which MDA is implemented. People were particularly disappointed with the limited attempts by implementers to share information and mobilize residents. In addition, negative sentiments towards MDA for lymphatic filariasis reflected a general feeling of desertion and marginalization by the health care system and political authorities. However, the results suggest that if the communities are brought on board with genuine respect for their integrity and informed self-determination, there is scope for major improvements in community support for MDA-based control activities.
淋巴丝虫病是几种被忽视的热带病之一，其具有严重致残和带来污名化的表现，被称为“贫困所致的被忽视疾病”。它是一种由蚊子传播的疾病，仅在低收入环境中呈地方性流行，而在这些环境中，公共卫生保健往往深陷困境，无法满足贫困人口的基本健康需求。这给大规模药物治疗（MDA）的实施带来了特殊挑战，而大规模药物治疗目前是控制和最终消除该病的主要手段。一些大规模药物治疗项目面临着两难境地，即它们无法在各目标群体中实现并维持所需的药物覆盖率。认识到这一点后，在坦桑尼亚的莫罗戈罗和林迪地区开展了一项定性研究，以了解社区对国家淋巴丝虫病消除计划于2011年开展的大规模药物治疗运动的经历和看法。该研究揭示了人们对大规模药物治疗的目标、基本原理和正当理由的看法和经历存在很大差异。人们对这些药物的有用性有积极看法，但许多研究参与者对大规模药物治疗的实施方式持怀疑态度。人们对实施者在分享信息和动员居民方面的有限努力尤其失望。此外，对淋巴丝虫病大规模药物治疗的负面看法反映了人们对医疗保健系统和政治当局普遍的被遗弃感和边缘化感。然而，研究结果表明，如果以真正尊重社区的完整性和知情的自决权为前提让社区参与进来，那么在社区对基于大规模药物治疗的控制活动的支持方面还有很大的改进空间。
