Tefera Worku, Tesfaye Hailu, Bekele Abeba, Kayessa Elias, Waltensperger Karen Z, Marsh David R
Ethiop Med J. 2014 Oct;52 Suppl 3:109-17.
Use and coverage of curative interventions for childhood pneumonia, diarrhea, and malaria were low in Ethiopia before integrated community-based case management (iCCM).
To examine factors accounting for low use of iCCMin Shebedino District applying a "Pathway to Sur- vival" approach to assess illness recognition; home care; labeling and decision-making; patterns of care-seeking; access, availability and quality of care; and referral.
Shortly after introduction of iCCM, we conducted five studies in Shebedino District in May 2011: a population-based household survey; focus group discussions of mothers of recently ill children; key informant in- terviews, including knowledge assessment, with Health Extension Workers at health posts and with health workers at health centers; and an inventory of drugs, supplies, and job aids at health posts and health centers.
The many barriers to use of evidence-based treatment included: (1) home remedies of uncertain effect and safety that delay care-seeking; (2) absent decision-maker; (3) fear of stigma; (4) expectation of non-availability of service or medicine; (5) geographic and financial barriers; (6) perception of (or actual) poor quality of care; and (7) accessible, available, affordable, reliable, non-standard, alternative sources of care.
Only a system-strengthening approach can overcome such manifold barriers to use of curative care that has not increased much after ICCM introduction.
在基于社区的综合病例管理（iCCM）实施之前，埃塞俄比亚针对儿童肺炎、腹泻和疟疾的治疗性干预措施的使用和覆盖情况较低。
采用“生存途径”方法来评估疾病识别、家庭护理、标签和决策、就医模式、医疗服务的可及性、可得性和质量以及转诊情况，以研究谢贝利诺区iCCM使用率低的影响因素。
在引入iCCM后不久，我们于2011年5月在谢贝利诺区开展了五项研究：一项基于人群的家庭调查；对近期患病儿童的母亲进行焦点小组讨论；对卫生站的卫生推广工作者和健康中心的卫生工作者进行关键信息访谈，包括知识评估；以及对卫生站和健康中心的药品、物资和工作辅助工具进行清点。
使用循证治疗存在诸多障碍，包括：（1）效果和安全性不确定的家庭疗法延误了就医；（2）决策者缺席；（3）害怕被污名化；（4）预期无法获得服务或药品；（5）地理和经济障碍；（6）对医疗服务质量差的认知（或实际情况）；以及（7）可及、可得、可负担、可靠、非标准的替代医疗服务来源。
只有加强系统的方法才能克服iCCM引入后治疗性护理使用方面未大幅增加的诸多障碍。
