Mpimbaza Arthur, Ndeezi Grace, Katahoire Anne, Rosenthal Philip J, Karamagi Charles
Child Health & Development Centre, Makerere University-College of Health Sciences, Kampala, Uganda.
Department of Pediatrics & Child Health, Makerere University-College of Health Sciences, Kampala, Uganda.
Am J Trop Med Hyg. 2017 Nov;97(5):1513-1523. doi: 10.4269/ajtmh.17-0056. Epub 2017 Oct 10.
We studied associations between delayed care seeking, demographic, socioeconomic, and geographic factors and likelihood of severe malaria in Ugandan children. The study was based at Jinja Hospital, Uganda. We enrolled 325 severe malaria cases and 325 uncomplicated malaria controls matched by age and residence. Patient details, an itinerary of events in response to illness, household information, and location of participants' residences were captured. Conditional logistic regression was used to determine risk factors for severe malaria and delayed care seeking. Delayed care seeking (≥ 24 hours after fever onset; odds ratio [OR] 5.50; 95% confidence interval [CI] 2.70, 11.1), seeking care at a drug shop as the initial response to illness (OR 3.62; 95% CI 1.86, 7.03), and increasing distance from place of residence to the nearest health center (OR 1.45; 95% CI 1.17, 1.79) were independent risk factors for severe malaria. On subgroup analysis, delayed care seeking was a significant risk factor in children with severe malaria attributable to severe anemia (OR 15.6; 95% CI 3.02, 80.6), but not unconsciousness (OR 1.13; 95% CI 0.30, 4.28). Seeking care at a drug shop (OR 2.84; 95% CI 1.12, 7.21) and increasing distance to the nearest health center (OR 1.18; 95% CI 1.01, 1.37) were independent risk factors for delayed care seeking. Delayed care seeking and seeking care at a drug shop were risk factors for severe malaria. Seeking care at a drug shop was also a predictor of delayed care seeking. The role of drug shops in contributing to delayed care and risk of severe malaria requires further study.
我们研究了乌干达儿童延迟就医、人口统计学、社会经济和地理因素与重症疟疾发生可能性之间的关联。该研究以乌干达金贾医院为基础。我们纳入了325例重症疟疾病例和325例按年龄和居住地匹配的非重症疟疾对照。收集了患者详细信息、患病后的事件行程、家庭信息以及参与者居住地点。采用条件逻辑回归来确定重症疟疾和延迟就医的风险因素。延迟就医（发热开始后≥24小时；比值比[OR] 5.50；95%置信区间[CI] 2.70，11.1）、作为患病后的初始反应在药店就医（OR 3.62；95% CI 1.86，7.03）以及从居住地到最近卫生中心的距离增加（OR 1.45；95% CI 1.17，1.79）是重症疟疾的独立风险因素。在亚组分析中，延迟就医是因严重贫血导致的重症疟疾患儿的显著风险因素（OR 15.6；95% CI 3.02，80.6），但不是昏迷患儿的显著风险因素（OR 1.13；95% CI 0.30，4.28）。在药店就医（OR 2.84；95% CI 1.12，7.21）和到最近卫生中心的距离增加（OR 1.18；95% CI 1.01，1.37）是延迟就医的独立风险因素。延迟就医和在药店就医是重症疟疾的风险因素。在药店就医也是延迟就医的一个预测因素。药店在导致延迟就医和重症疟疾风险方面的作用需要进一步研究。
