Masangwi Salule, Ferguson Neil, Grimason Anthony, Morse Tracy, Kazembe Lawrence
Centre for Water, Sanitation, Health and Appropriate Technology Development, University of Malawi, The Polytechnic, P/B 303, Chichiri, Blantyre 3, Malawi.
Department of Mathematics and Statistics, University of Malawi, The Polytechnic, P/B 303, Chichiri, Blantyre 3, Malawi.
Int J Environ Res Public Health. 2016 Nov 15;13(11):1140. doi: 10.3390/ijerph13111140.
This paper examined care-seeking behaviour and its associated risk factors when a family member had diarrhoea. Data was obtained from a survey conducted in Chikwawa, a district in Southern Malawi. Chikwawa is faced with a number of environmental and socioeconomic problems and currently diarrhoea morbidity in the district is estimated at 24.4%, statistically higher than the national average of 17%. Using hierarchically built data from a survey of 1403 households nested within 33 communities, a series of two level binary logistic regression models with Bayesian estimation were used to determine predictors of care-seeking behaviour. The results show that 68% of mothers used oral rehydration solutions (ORS) the last time a child in their family had diarrhoea. However, when asked on the action they take when a member of their household has diarrhoea two thirds of the mothers said they visit a health facility. Most respondents (73%) mentioned distance and transport costs as the main obstacles to accessing their nearest health facility and the same proportion of respondents mentioned prolonged waiting time and absence of health workers as the main obstacles encountered at the health facilities. The main predictor variables when a member of the family had diarrhoea were maternal age, distance to the nearest health facility, school level, and relative wealth, household diarrhoea endemicity, and household size while the main predictor variables when a child had diarrhoea were existence of a village health committee (VHC), distance to the nearest health facility, and maternal age. Most households use ORS for the treatment of diarrhoea and village health committees and health surveillance assistants (HSAs) are important factors in this choice of treatment. Health education messages on the use and efficacy of ORS to ensure proper and prescribed handling are important. There is need for a comprehensive concept addressing several dimensions of management and proper coordination of delivery of resources and services; availability of adequate healthcare workers at all levels; affordability to accessibility of healthcare resources and services to all communities; acceptability and quality of care; intensification of health education messages on the use and management of ORS, and prompt and timely treatment of diarrhoeal illness.
本文研究了家庭成员出现腹泻时的就医行为及其相关风险因素。数据来源于在马拉维南部奇夸瓦区进行的一项调查。奇夸瓦面临诸多环境和社会经济问题,目前该地区腹泻发病率估计为24.4%,从统计学上看高于全国平均水平17%。利用对33个社区内1403户家庭进行调查所构建的分层数据,采用一系列具有贝叶斯估计的二级二元逻辑回归模型来确定就医行为的预测因素。结果显示,上次家中孩子出现腹泻时,68%的母亲使用了口服补液盐(ORS)。然而,当被问及家中成员出现腹泻时她们采取的行动时,三分之二的母亲表示会前往医疗机构。大多数受访者(73%)提到距离和交通成本是前往最近医疗机构的主要障碍,同样比例的受访者提到等待时间过长和医护人员不在岗是在医疗机构遇到的主要障碍。家庭成员出现腹泻时的主要预测变量是母亲年龄、到最近医疗机构的距离、受教育程度、相对财富、家庭腹泻流行情况和家庭规模,而孩子出现腹泻时的主要预测变量是村卫生委员会(VHC)的存在、到最近医疗机构的距离和母亲年龄。大多数家庭使用ORS治疗腹泻,村卫生委员会和健康监测助理(HSA)是这一治疗选择的重要因素。关于ORS使用和功效的健康教育信息对于确保正确和规范使用很重要。需要一个综合概念,涵盖管理的多个层面以及资源和服务提供的适当协调;各级有足够的医护人员;所有社区都能负担得起并获得医疗资源和服务;护理的可接受性和质量;加强关于ORS使用和管理的健康教育信息,以及对腹泻疾病的及时治疗。
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