Pang Junxiong, Hildon Zoe Jane-Lara, Thein Tun Linn, Jin Jing, Leo Yee Sin
Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 144 Moulmein Road, Singapore, 308089, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
BMC Infect Dis. 2017 Jun 15;17(1):428. doi: 10.1186/s12879-017-2525-3.
Dengue results in high morbidity and mortality globally. The knowledge, attitude and practices (KAP) of dengue management, including diagnosis, among primary care physicians (PCPs) are important to reduce dengue transmission and burden. However, there is a lack of understanding on the impact of dengue epidemic on dengue management. Hence, the aim of this study is to examine the changes in KAP on dengue management among PCPs before and after the largest dengue epidemic in 2013 in Singapore.
Surveys were mailed to 2000 and 1514 PCPs registered under the Singapore Medical Council in March of year 2011 and 2014, respectively. Survey data were then collected between April and June of that year. Chi-square or Fisher's exact test was used for comparing categorical variables. A multivariate logistic regression model was implemented to determine independent factors for frequent use of dengue diagnostic tests (DDTs). All tests were conducted at 5% level of significance. Adjusted odds ratio and corresponding 95% confidence intervals were reported, where applicable. Qualitative data were descriptively coded for themes and analysis.
Among PCPs surveyed in 2011 and 2014, 89.9% and 86% had good knowledge on dengue management respectively. The usage of DDTs had increased significantly in 2014 (N = 164;56%) as compared to 2011 (N = 107;29.5%) in both private and public clinics (p < 0.001). Dengue Duo point-of-care test (POCT) kits was independently associated with frequent use of DDTs (adjusted odds ratio = 2.15; 95% confidence interval = 1.25-3.69). There was a significant reduction in referral of dengue patients to hospital (31.4% in 2011; 13.3% in 2014; p < 0.001), and a significant increase in frequency of clinic follow-ups (18.4% in 2011; 28.5% in 2014; p = 0.003). One key theme highlighted was that dengue management can be improved with availability of POCT kit, better awareness of the disease and any revised clinical guidelines.
The knowledge on dengue management remained high, while the attitude and practices, particularly on the usage of DDTs improved significantly after a large epidemic. Furthermore, PCPs had more confident in managing dengue patients in primary care settings and in educating patients on the importance of vector control and dengue warning signs to reduce dengue transmission and burden.
登革热在全球范围内导致高发病率和死亡率。基层医疗医生（PCP）对登革热管理（包括诊断）的知识、态度和实践（KAP）对于减少登革热传播和负担至关重要。然而，对于登革热疫情对登革热管理的影响缺乏了解。因此，本研究的目的是调查2013年新加坡最大规模登革热疫情前后基层医疗医生对登革热管理的KAP变化情况。
分别于2011年3月和2014年3月向新加坡医学委员会注册的2000名和1514名基层医疗医生邮寄调查问卷。然后在当年4月至6月收集调查数据。采用卡方检验或Fisher精确检验比较分类变量。实施多变量逻辑回归模型以确定频繁使用登革热诊断测试（DDT）的独立因素。所有检验均在5%的显著性水平下进行。适用时报告调整后的比值比和相应的95%置信区间。对定性数据进行主题编码和描述性分析。
在2011年和2014年接受调查的基层医疗医生中，分别有89.9%和86%对登革热管理有良好的知识水平。与2011年（N = 107；29.5%）相比，2014年（N = 164；56%）私立和公立诊所中DDT的使用均显著增加（p < 0.001）。登革热双点即时检验（POCT）试剂盒与频繁使用DDT独立相关（调整后的比值比 = 2.15；95%置信区间 = 1.25 - 3.69）。转诊至医院的登革热患者显著减少（2011年为31.4%；2014年为13.3%；p < 0.001），诊所随访频率显著增加（2011年为18.4%；2014年为28.5%；p = 0.003）。突出的一个关键主题是，POCT试剂盒的可用性、对该疾病的更好认识以及任何修订的临床指南都可以改善登革热管理。
登革热管理知识水平仍然较高，而在一次大规模疫情后，态度和实践，特别是DDT的使用显著改善。此外，基层医疗医生在基层医疗环境中管理登革热患者以及就病媒控制和登革热警示标志的重要性对患者进行教育以减少登革热传播和负担方面更有信心。
