Ingabire Chantal Marie, Kateera Fredrick, Hakizimana Emmanuel, Rulisa Alexis, Muvunyi Claude, Mens Petra, Koenraadt Constantianus J M, Mutesa Leon, Van Vugt Michele, Van Den Borne Bart, Alaii Jane
Medical Research Center, Rwanda Biomedical Center, Kigali, Rwanda.
Department of Health Promotion, Maastricht University, Maastricht, The Netherlands.
Malar J. 2016 Apr 21;15:227. doi: 10.1186/s12936-016-1285-7.
In order to understand factors influencing fever/malaria management practices among community-based individuals, the study evaluated psychosocial, socio-demographic and environmental determinants of prompt and adequate healthcare-seeking behaviours.
A quantitative household (HH) survey was conducted from December 2014 to February 2015 in Ruhuha sector, Bugesera district in the Eastern province of Rwanda. HHs that reported having had at least one member who experienced a fever and/or malaria episode in the previous 3 months prior to the study were included in the analysis. Healthcare-seeking behaviours associated with the last episode of illness were analysed. Socio-demographic, health facility access, long-lasting insecticidal-treated nets (LLINs), data on malaria knowledge, data and theory of planned behaviour (TPB) related variables (attitudes, subjective norms, perceived behavioural control) with regard to fever/malaria healthcare seeking, were collected. The primary outcome was prompt and adequate care defined as: (1) seeking advice or treatment at a health facility (health centre or hospital) or from a community health worker (CHW); (2) advice or treatment seeking within same/next day of symptoms onset; (3) received a laboratory diagnosis; (4) received advice or treatment; and, (5) reported completing the prescribed dose of medication. Determinants of prompt and adequate care among presumed malaria cases were evaluated using a logistic regression analysis.
Overall, 302 (21 %) of the 1410 interviewed HHs reported at least one member as having experienced a fever or malaria within the 3 months prior to the survey. The number of HHs (where at least one member reported fever/malaria) that reported seeking advice or treatment at a health facility (health centre or hospital) or from a CHW was 249 (82.4 %). Of those who sought advice or treatment, 87.3 % had done so on same/next day of symptoms developing, 82.8 % received a laboratory diagnosis, and more than 90 % who received treatment reported completing the prescribed dosage. Prompt and adequate care was reported from 162 of the 302 HHs (53.6 %) that experienced fever or malaria for one or more HH members. Bivariate analyses showed that head of household (HoH)-related characteristics including reported knowledge of three or more malaria symptoms, having health insurance, being able to pay for medical services, use of LLINs the night before the survey, having a positive attitude, perceiving social support, as well as a high-perceived behavioural control with regard to healthcare seeking, were all significantly associated with prompt and adequate care. In the final logistic regression model, a high-perceived behavioural control (odds ratio (OR) 5.068, p = 0.042), having a health insurance (OR 2.410, p = 0.044) and having knowledge of malaria symptoms (OR 1.654, p = 0.049) significantly predicted prompt and adequate care.
To promote prompt and adequate care seeking for malaria in the area, particular emphasis should be placed on community-focused strategies that promote early malaria symptom recognition, increased health insurance coverage and enhanced perceived behavioural control with regard to healthcare-seeking.
为了解影响社区居民发热/疟疾管理行为的因素，本研究评估了及时和充分寻求医疗行为的心理社会、社会人口学和环境决定因素。
2014年12月至2015年2月在卢旺达东部省布热塞拉区鲁胡哈县进行了一项定量家庭调查。分析对象包括在研究前3个月内报告至少有一名成员经历过发热和/或疟疾发作的家庭。分析了与最近一次疾病发作相关的就医行为。收集了社会人口学、卫生设施可及性、长效驱虫蚊帐（LLINs）、疟疾知识数据以及与发热/疟疾就医相关的计划行为理论（TPB）变量（态度、主观规范、感知行为控制）。主要结局定义为及时和充分的护理，包括：（1）在卫生设施（卫生中心或医院）或向社区卫生工作者（CHW）寻求建议或治疗；（2）在症状出现当天或次日寻求建议或治疗；（3）接受实验室诊断；（4）接受建议或治疗；以及（5）报告完成规定剂量的药物治疗。使用逻辑回归分析评估假定疟疾病例中及时和充分护理的决定因素。
总体而言，在1410个接受访谈的家庭中，有302个（21%）报告在调查前3个月内至少有一名成员经历过发热或疟疾。报告在卫生设施（卫生中心或医院）或向社区卫生工作者寻求建议或治疗的家庭（其中至少一名成员报告发热/疟疾）有249个（82.4%）。在那些寻求建议或治疗的人中，87.3%在症状出现当天或次日就进行了就医，82.8%接受了实验室诊断，超过90%接受治疗的人报告完成了规定剂量的治疗。在302个有一名或多名家庭成员经历过发热或疟疾的家庭中，有162个（53.6%）报告得到了及时和充分的护理。双变量分析表明，与户主相关的特征，包括报告了解三种或更多疟疾症状、拥有医疗保险、能够支付医疗服务费用、在调查前一晚使用长效驱虫蚊帐、态度积极、感知到社会支持以及对就医有较高的感知行为控制，均与及时和充分的护理显著相关。在最终的逻辑回归模型中，较高的感知行为控制（比值比（OR）5.068，p = 0.042）、拥有医疗保险（OR 2.410，p = 0.044）和了解疟疾症状（OR 1.654，p = 0.049）显著预测了及时和充分的护理。
为促进该地区疟疾的及时和充分护理，应特别强调以社区为重点的策略，以促进早期疟疾症状识别、提高医疗保险覆盖率并增强对就医的感知行为控制。
