Mbonye Anthony K, Buregyeya Esther, Rutebemberwa Elizeus, Clarke Siân E, Lal Sham, Hansen Kristian S, Magnussen Pascal, LaRussa Philip
Ministry of Health, Directorate of Clinical and Community Services, Kampala and Department of Community and Behavioural Sciences, School of Public Health, Makerere University, Box 7272, Kampala, Uganda.
Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
Malar J. 2016 Apr 14;15:212. doi: 10.1186/s12936-016-1245-2.
Malaria in pregnancy is a major public health problem in Uganda; and it is the leading cause of anaemia among pregnant women and low birth weight in infants. Previous studies have noted poor quality of care in the private sector. Thus there is need to explore ways of improving quality of care in the private sector that provides almost a half of health services in Uganda.
A survey was conducted from August to October 2014 within 57 parishes in Mukono district, central Uganda. The selected parishes had a minimum of 200 households and at least one registered drug shop, pharmacy or private clinic. Data was collected using a structured questionnaire targeting one provider who was found on duty in each selected private health facility and consented to the study. The main variables were: provider characteristics, previous training received, type of drugs stocked, treatment and prevention practices for malaria among pregnant women. The main study outcome was the proportion of private health facilities who prescribe treatment of fever among pregnant women as recommended in the guidelines.
A total of 241 private health facilities were surveyed; 70.5 % were registered drug shops, 24.5 % private clinics and 5.0 % pharmacies. Treatment of fever among pregnant women in accordance with the national treatment guidelines was poor: 40.7 % in private clinics, decreasing to 28.2 % in drug shops and 16.7 % at pharmacies. Anti-malarial monotherapies sulphadoxine-pyrimethamine and quinine were commonly prescribed, often without consideration of gestational age. The majority of providers (>75 %) at all private facilities prescribed SP for intermittent preventive treatment but artemisinin-based combination therapy was prescribed: 8.3, 6.9 and 8.3 % respectively at drug shops, private clinics and pharmacies for prevention of malaria in pregnancy. Few facilities had malaria treatment guidelines; (44.1 % of private clinics, 17.9 % of drug shops, and 41.7 % at pharmacies. Knowledge of people at risk of malaria, P = 0.02 and availability of malaria treatment guidelines, P = 0.03 were the factors that most influenced correct treatment of fever in pregnancy.
Treatment of fever during pregnancy was poor in this study setting. These data highlight the need to develop interventions to improve patient safety and quality of care for pregnant women in the private health sector in Uganda.
妊娠疟疾是乌干达的一个主要公共卫生问题；它是孕妇贫血和婴儿低出生体重的主要原因。以往研究指出私营部门的医疗服务质量较差。因此，有必要探索提高乌干达提供近一半医疗服务的私营部门医疗服务质量的方法。
2014年8月至10月在乌干达中部穆科诺区的57个教区进行了一项调查。所选教区至少有200户家庭且至少有一家注册药店、药房或私人诊所。使用结构化问卷收集数据，目标是在每个选定的私营医疗机构中值班且同意参与研究的一名提供者。主要变量包括：提供者特征、接受过的既往培训、所储备药品类型、孕妇疟疾的治疗和预防措施。主要研究结果是按照指南建议为孕妇开具发热治疗药物的私营医疗机构的比例。
共调查了241家私营医疗机构；70.5%是注册药店，24.5%是私人诊所，5.0%是药房。按照国家治疗指南对孕妇发热进行治疗的情况较差：私人诊所为40.7%，药店降至28.2%，药房为16.7%。抗疟单一疗法磺胺多辛 - 乙胺嘧啶和奎宁被普遍开具，通常不考虑孕周。所有私营医疗机构中大多数提供者（>75%）为间歇性预防治疗开具了磺胺多辛 - 乙胺嘧啶，但基于青蒿素的联合疗法的开具比例分别为：药店8.3%、私人诊所6.9%、药房8.3%用于预防妊娠疟疾。很少有机构有疟疾治疗指南；（私人诊所44.1%、药店17.9%、药房41.7%）。疟疾高危人群的知晓情况（P = 0.02）和疟疾治疗指南的可得性（P = 0.03）是最影响孕期发热正确治疗的因素。
在本研究环境中，孕期发热的治疗情况较差。这些数据凸显了在乌干达私营卫生部门制定干预措施以提高孕妇患者安全和医疗服务质量的必要性。
