乌干达公立与私立医疗机构管理五岁以下发热儿童能力的比较。
Comparison of the capacity between public and private health facilities to manage under-five children with febrile illnesses in Uganda.
作者信息
Buregyeya Esther, Rutebemberwa Elizeus, LaRussa Phillip, Lal Sham, Clarke Sîan E, Hansen Kristian S, Magnussen Pascal, Mbonye Anthony K
机构信息
Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
出版信息
Malar J. 2017 May 2;16(1):183. doi: 10.1186/s12936-017-1842-8.
BACKGROUND
Public health facilities are usually the first to receive interventions compared to private facilities, yet majority of health seeking care is first done with the latter. This study compared the capacity to manage acute febrile illnesses in children below 5 years in private vs public health facilities in order to design interventions to improve quality of care.
METHODS
A survey was conducted within 57 geographical areas (parishes), from August to October 2014 in Mukono district, central Uganda. The survey comprised both facility and health worker assessment. Data were collected on drug stocks, availability of treatment guidelines, diagnostic equipment, and knowledge in management of malaria, pneumonia and diarrhoea, using a structured questionnaire.
RESULTS
A total of 53 public and 241 private health facilities participated in the study. While similar proportions of private and public health facilities stocked Coartem, the first-line anti-malarial drug, (98 vs 95%, p = 0.22), significantly more private than public health facilities stocked quinine (85 vs 53%, p < 0.01). Stocks of obsolete anti-malarial drugs, such as chloroquine, were reported in few public and private facilities (3.7 vs 12.5%, p = 0.06). Stocks of antibiotics-amoxycillin and gentamycin were similar in both sectors (≥90% for amoxicillin; ≥50 for gentamycin). Training in malaria was reported by 65% of public health facilities vs 56% in the private sector, p = 0.25), while, only 21% in the public facility and 12% in the private facilities, p = 0.11, reported receiving training in pneumonia. Only 55% of public facilities had microscopes. Malaria treatment guidelines were significantly lacking in the private sector, p = 0.01. Knowledge about first-line management of uncomplicated malaria, pneumonia and diarrhoea was significantly better in the public facilities compared to the private ones, though still sub-optimal.
CONCLUSION
Deficiencies of equipment, supplies and training exist even in public health facilities. In order to significantly improve the capacity to handle acute febrile illness among children under five, training in proper case management, availability of supplies and diagnostics need to be addressed in both sectors.
背景
与私立医疗机构相比，公共卫生设施通常最先接受干预措施，但大多数寻求医疗服务的人首先会选择后者。本研究比较了私立和公共卫生设施对5岁以下儿童急性发热性疾病的管理能力，以便设计干预措施来提高医疗质量。
方法
2014年8月至10月，在乌干达中部穆科诺区的57个地理区域（教区）内进行了一项调查。该调查包括医疗机构和卫生工作者评估。使用结构化问卷收集了有关药品库存、治疗指南的可用性、诊断设备以及疟疾、肺炎和腹泻管理知识的数据。
结果
共有53家公共卫生设施和241家私立卫生设施参与了该研究。虽然私立和公共卫生设施中储存一线抗疟药物科泰复（Coartem）的比例相似（98%对95%，p = 0.22），但储存奎宁的私立卫生设施明显多于公共卫生设施（85%对53%，p < 0.01）。在少数公共和私立卫生设施中报告了过期抗疟药物如氯喹的库存（3.7%对12.5%，p = 0.06）。抗生素阿莫西林和庆大霉素在两个部门的库存相似（阿莫西林≥90%；庆大霉素≥50%）。65%的公共卫生设施报告接受过疟疾培训，而私立部门为56%，p = 0.25），而只有21%的公共设施和12%的私立设施报告接受过肺炎培训，p = 0.11）。只有55%的公共设施有显微镜。私立部门明显缺乏疟疾治疗指南，p = 0.01）。与私立设施相比，公共设施中关于单纯性疟疾、肺炎和腹泻一线管理的知识明显更好，尽管仍未达到最佳水平。
结论
即使在公共卫生设施中也存在设备、物资和培训方面的不足。为了显著提高五岁以下儿童处理急性发热性疾病的能力，两个部门都需要解决适当病例管理培训、物资供应和诊断方面的问题。
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