Djouma Fabrice N, Ateudjieu Jerome, Ram Malathi, Debes Amanda K, Sack David A
Meilleur Accès aux Soins de Santé (M.A. SANTE), Yaoundé, Cameroon.
Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon.
Am J Trop Med Hyg. 2016 Dec 7;95(6):1287-1291. doi: 10.4269/ajtmh.16-0300. Epub 2016 Oct 17.
This study demonstrates that most cholera deaths in this region of Cameroon occur out of hospital. This is a region which is prone to cholera, and interventions are needed to improve access to emergency medical care, especially during cholera outbreaks. Cameroon has experienced 14 cholera epidemics during the last 20 years, and these have had high case fatality rates. This study attempted to assess the effect of delays in seeking care and the locations of care as possible risk factors for cholera mortality. The study used data from a community-based survey regarding the circumstances of 97 fatal cases and 197 control (nonfatal) cases following a cholera-like syndrome in villages with cholera-like diseases during cholera outbreaks in Cameroon during 2009-2011. Deaths occurred in one of four environments: the community, in a temporary community treatment center (TCTC), in transit to a treatment center, or in a hospital (39%, 32%, 5%, and 24%, respectively). Using a case-control analysis, factors associated with deaths included the nonuse of a cholera treatment center, receiving health care in a TCTC instead of a hospital, and greater than 4 hours delay between the onset of symptoms and the decision to go to a treatment center (odds ratios of 17.1 [confidence interval (CI): 7.0-41.8], 2.5 [CI: 1.2-5.0], and 2.2 [CI: 1.0-4.6], respectively). During cholera epidemics, a higher proportion of deaths are still occurring in communities. The nonuse and delays in deciding to go a treatment center, and treatment at TCTC rather than a hospital were risk factors for death among patients with cholera-like syndrome in Cameroon. Informing people on community management of cholera-like syndrome and improving care in all health facilities are needed to reduce deaths during cholera epidemics.
本研究表明，喀麦隆这一地区的大多数霍乱死亡发生在医院外。该地区容易发生霍乱，需要采取干预措施以改善获得紧急医疗护理的机会，尤其是在霍乱疫情期间。喀麦隆在过去20年中经历了14次霍乱疫情，且病死率很高。本研究试图评估寻求治疗的延迟以及治疗地点作为霍乱死亡可能危险因素的影响。该研究使用了来自一项基于社区调查的数据，该调查涉及2009 - 2011年喀麦隆霍乱疫情期间霍乱样疾病村庄中97例死亡病例和197例对照（非致命）病例的情况。死亡发生在以下四种环境之一：社区、临时社区治疗中心（TCTC）、前往治疗中心途中或医院（分别为39%、32%、5%和24%）。通过病例对照分析，与死亡相关的因素包括未使用霍乱治疗中心、在临时社区治疗中心而非医院接受医疗护理，以及症状出现到决定前往治疗中心之间延迟超过4小时（比值比分别为17.1[置信区间（CI）：7.0 - 41.8]、2.5[CI：1.2 - 5.0]和2.2[CI：1.0 - 4.6]）。在霍乱疫情期间，社区中仍有较高比例的死亡发生。未使用治疗中心、决定前往治疗中心的延迟以及在临时社区治疗中心而非医院接受治疗是喀麦隆霍乱样综合征患者死亡的危险因素。需要向人们宣传霍乱样综合征的社区管理方法，并改善所有医疗机构的护理，以减少霍乱疫情期间的死亡人数。
