乌干达中部地区用于儿童疾病社区管理的药品供应受哪些因素影响？对扩大综合社区病例管理项目的启示。

What influences availability of medicines for the community management of childhood illnesses in central Uganda? Implications for scaling up the integrated community case management programme.

作者信息

Bagonza James, Rutebemberwa Elizeus, Eckmanns Tim, Ekirapa-Kiracho Elizabeth

机构信息

Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.

Robert Koch Institute, Berlin, Germany.

出版信息

BMC Public Health. 2015 Nov 25;15:1180. doi: 10.1186/s12889-015-2525-4.

DOI:10.1186/s12889-015-2525-4

PMID:26608029

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4660670/

Abstract

BACKGROUND

The integrated Community Case Management (iCCM) of childhood illnesses strategy has been adopted world over to reduce child related ill health and mortality. Community Health workers (CHWs) who implement this strategy need a regular supply of drugs to effectively treat children under 5 years with malaria, pneumonia and diarrhea. In this paper, we report the prevalence and factors influencing availability of medicines for managing malaria, pneumonia and diarrhea in communities in central Uganda.

METHODS

A cross sectional study was conducted among 303 CHWs in Wakiso district in central Uganda. Eligible CHWs from two randomly selected Health Sub Districts (HSDs) were interviewed. Questionnaires, check lists, record reviews were used to collect information on CHW background characteristics, CHW's prescription behaviors, health system support factors and availability of iCCM drugs. Multivariable logistic regression analysis was done to assess factors associated with availability of iCCM drugs.

RESULTS

Out of 300 CHWs, 239 (79.9%) were females and mean age was 42.1 (standard deviation =11.1 years). The prevalence of iCCM drug availability was 8.3% and 33 respondents (11%) had no drugs at all. Factors associated with iCCM drug availability were; being supervised within the last month (adjusted OR = 3.70, 95% CI 1.22-11.24), appropriate drug prescriptions (adjusted OR = 3.71, 95% CI 1.38-9.96), regular submission of drug reports (adjusted OR = 4.02, 95% CI 1.62-10.10) and having a respiratory timer as a diagnostic tool (adjusted OR =3.11, 95% CI 1.08-9.00).

CONCLUSIONS

The low medicine stocks for the community management of childhood illnesses calls for strengthening of CHW supervision, medicine prescription and reporting, and increasing availability of functional diagnostic tools.

摘要

背景

儿童疾病综合社区管理（iCCM）策略已在全球范围内采用，以减少与儿童相关的健康问题和死亡率。实施该策略的社区卫生工作者（CHW）需要定期供应药物，以有效治疗5岁以下患有疟疾、肺炎和腹泻的儿童。在本文中，我们报告了乌干达中部社区中用于管理疟疾、肺炎和腹泻药物的可及性及其影响因素。

方法

在乌干达中部瓦基索区的303名社区卫生工作者中进行了一项横断面研究。对来自两个随机选择的卫生次区（HSD）的符合条件的社区卫生工作者进行了访谈。通过问卷、清单、记录审查来收集有关社区卫生工作者背景特征、社区卫生工作者的处方行为、卫生系统支持因素以及iCCM药物可及性的信息。进行多变量逻辑回归分析以评估与iCCM药物可及性相关的因素。

结果

在300名社区卫生工作者中，239名（79.9%）为女性，平均年龄为42.1岁（标准差=11.1岁）。iCCM药物的可及率为8.3%，33名受访者（11%）完全没有药物。与iCCM药物可及性相关的因素有：在过去一个月内受到监督（调整后比值比=3.70，95%置信区间1.22 - 11.24）、适当的药物处方（调整后比值比=3.71，95%置信区间1.38 - 9.96）、定期提交药物报告（调整后比值比=4.02，95%置信区间1.62 - 10.10）以及拥有呼吸定时器作为诊断工具（调整后比值比=3.11，95%置信区间1.08 - 9.00）。