Degrémont A, Lwihula G K, Mayombana C, Burnier E, de Savigny D, Tanner M
Swiss Tropical Institute Basel, Switzerland.
Acta Trop. 1987 Jun;44(2):175-90.
Standardised household interviews among adults and children, open-ended questionnaires, and clinical examinations administered during cross-sectional health status surveys, as well as the registers of village health posts (VHP), were used to assess the pattern of health problems of a rural community in southeastern Tanzania, and their results compared. All four approaches gave very similar results for the two major health problems (fever/malaria and abdominal pain or discomfort) which were mentioned by both children and adults. The parasitological data from the cross-sectional surveys also revealed hyperendemic P. falciparum malaria and a high prevalence and incidence for infections with hookworm (N. americanus), Strongyloides, and G. lamblia. However besides consistently revealing the two major health problems, each approach showed a distinct pattern for the additional health problems: household interviews and open-ended questionnaires resulted in a higher ranking of problems that had not yet been solved by the health care facilities available in the community at the time of the interview. This view was further biased by the fact that the interviews were done by people representing the health professionals. The statistics from the registers of VHP clearly reflected the types of treatment provided by this service. Malnutrition and various eye problems only became evident during the clinical examination of the population. However, the clinical examination did not identify the importance of the abdominal problems in the community. The cross-sectional survey (questionnaires, clinical examination) chiefly showed the health problems affecting the population around the time of the surveys (end of the dry season). Interestingly, the registers of the VHP did not show marked seasonal variations in the morbidity statistics for this community. Both questionnaire approaches and the registers of VHP showed a change in both the morbidity and the disease perception pattern that may reflect the effects of interventions launched at community level (activities of village health workers, mass-treatment against hookworm and G. lamblia). The study indicated that the individual ranking of the major health problems matched with data from health status surveys. It also pointed to the possibility that disease perception patterns could become a tool for community diagnosis and for the monitoring of health care programs.
在坦桑尼亚东南部的一个农村社区进行横断面健康状况调查期间，对成人和儿童进行标准化的家庭访谈、开放式问卷调查、临床检查，以及利用乡村卫生站（VHP）的登记册，来评估该社区的健康问题模式，并对结果进行比较。对于儿童和成人都提到的两个主要健康问题（发烧/疟疾以及腹痛或不适），这四种方法得出的结果非常相似。横断面调查的寄生虫学数据还显示，恶性疟原虫疟疾高度流行，钩虫（美洲板口线虫）、粪类圆线虫和蓝氏贾第鞭毛虫感染的患病率和发病率很高。然而，除了始终揭示这两个主要健康问题外，每种方法对于其他健康问题都呈现出不同的模式：家庭访谈和开放式问卷调查导致对访谈时社区现有医疗设施尚未解决的问题有更高的排名。由于访谈是由代表卫生专业人员的人进行的，这种观点进一步受到了偏见的影响。VHP登记册的统计数据清楚地反映了该服务提供的治疗类型。营养不良和各种眼部问题仅在对人群进行临床检查时才变得明显。然而，临床检查并未确定腹部问题在社区中的重要性。横断面调查（问卷调查、临床检查）主要显示了调查时（旱季结束时）影响人群的健康问题。有趣的是，VHP的登记册并未显示该社区发病率统计数据有明显的季节性变化。问卷调查方法和VHP登记册都显示发病率和疾病认知模式发生了变化，这可能反映了社区层面开展的干预措施（乡村卫生工作者的活动、针对钩虫和蓝氏贾第鞭毛虫的群体治疗）的效果。该研究表明，主要健康问题的个体排名与健康状况调查的数据相符。它还指出，疾病认知模式有可能成为社区诊断和医疗保健项目监测的工具。
