Kojima Noah, Krupp Karl, Ravi Kavitha, Gowda Savitha, Jaykrishna Poornima, Leonardson-Placek Caitlyn, Siddhaiah Anand, Bristow Claire C, Arun Anjali, Klausner Jeffrey D, Madhivanan Purnima
David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, 90095, CA, USA.
Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India.
BMC Infect Dis. 2017 Mar 6;17(1):189. doi: 10.1186/s12879-017-2282-3.
In rural India, mobile medical clinics are useful models for delivering health promotion, education, and care. Mobile medical clinics use fewer providers for larger catchment areas compared to traditional clinic models in resource limited settings, which is especially useful in areas with shortages of healthcare providers and a wide geographical distribution of patients.
From 2008 to 2011, we built infrastructure to implement a mobile clinic system to educate rural communities about maternal child health, train community health workers in common safe birthing procedures, and provide comprehensive antenatal care, prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), and testing for specific infections in a large rural catchment area of pregnant women in rural Mysore. This was done using two mobile clinics and one walk-in clinic. Women were tested for HIV, hepatitis B, syphilis, and bacterial vaginosis along with random blood sugar, urine albumin, and anemia. Sociodemographic information, medical, and obstetric history were collected using interviewer-administered questionnaires in the local language, Kannada. Data were entered in Microsoft Excel and analyzed using Stata SE 14.1.
During the program period, nearly 700 community workers and 100 health care providers were trained; educational sessions were delivered to over 15,000 men and women and integrated antenatal care and HIV/sexually transmitted infection testing was offered to 3545 pregnant women. There were 22 (0.6%) cases of HIV, 19 (0.5%) cases of hepatitis B, 2 (0.1%) cases of syphilis, and 250 (7.1%) cases of BV, which were identified and treated. Additionally, 1755 (49.5%) cases of moderate to severe anemia and 154 (4.3%) cases of hypertension were identified and treated among the pregnant women tested.
Patient-centered mobile medical clinics are feasible, successful, and acceptable models that can be used to provide quality healthcare to pregnant women in rural and hard-to-reach settings. The high numbers of pregnant women attending mobile medical clinics show that integrated antenatal care with PMTCT services were acceptable and utilized. The program also developed and trained health professionals who continue to remain in those communities.
在印度农村地区，流动医疗诊所是提供健康促进、教育及护理的有效模式。与资源有限环境中的传统诊所模式相比，流动医疗诊所在更大的服务区域使用的医护人员较少，这在医疗服务提供者短缺且患者地理分布广泛的地区尤为有用。
2008年至2011年期间，我们建立了基础设施以实施流动诊所系统，向农村社区开展母婴健康方面的教育，对社区卫生工作者进行常见安全分娩程序培训，并在迈索尔农村地区的一个大型农村孕妇服务区域提供全面的产前护理、预防人类免疫缺陷病毒（HIV）母婴传播（PMTCT）以及特定感染检测。这通过两个流动诊所和一个无需预约的诊所来完成。对妇女进行了HIV、乙型肝炎、梅毒和细菌性阴道病检测，同时检测随机血糖、尿白蛋白和贫血情况。使用当地语言卡纳达语由访谈员管理的问卷收集社会人口统计学信息、医疗和产科病史。数据录入Microsoft Excel并使用Stata SE 14.1进行分析。
在项目期间，培训了近700名社区工作者和100名医疗服务提供者；为超过15000名男性和女性开展了教育课程，并为3545名孕妇提供了综合产前护理和HIV/性传播感染检测。共发现并治疗了22例（0.6%）HIV病例、19例（0.5%）乙型肝炎病例、2例（0.1%）梅毒病例和250例（7.1%）细菌性阴道病病例。此外，在接受检测的孕妇中，发现并治疗了1755例（49.5%）中重度贫血病例和154例（4.3%）高血压病例。
以患者为中心的流动医疗诊所是可行、成功且可接受的模式，可用于为农村及难以到达地区的孕妇提供优质医疗服务。大量孕妇前往流动医疗诊所表明，综合产前护理与PMTCT服务是可接受且得到利用的。该项目还培养并培训了继续留在这些社区的卫生专业人员。
