在秘鲁亚马逊地区预防疟疾：秘鲁伊基托斯的定性研究。
Preventing malaria in the Peruvian Amazon: a qualitative study in Iquitos, Peru.
机构信息
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
出版信息
Malar J. 2018 Jan 16;17(1):31. doi: 10.1186/s12936-018-2177-9.
BACKGROUND
In Peru, despite decades of concerted control efforts, malaria remains a significant public health burden. Peru has recently exhibited a dramatic rise in malaria incidence, impeding South America's progress towards malaria elimination. The Amazon basin, in particular the Loreto region of Peru, has been identified as a target for the implementation of intensified control strategies, aiming for elimination. No research has addressed why vector control strategies in Loreto have had limited impact in the past, despite vector control elsewhere being highly effective in reducing malaria transmission. This study employed qualitative methods to explore factors limiting the success of vector control strategies in the region.
METHODS
Twenty semi-structured interviews were conducted among adults attending a primary care centre in Iquitos, Peru, together with 3 interviews with key informants (health care professionals). The interviews focussed on how local knowledge, together with social and cultural attitudes, determined the use of vector control methods.
RESULTS
Five themes emerged. (a) Participants believed malaria to be embedded within their culture, and commonly blamed this for a lack of regard for prevention. (b) They perceived a shift in mosquito biting times to early evening, rendering night-time use of bed nets less effective. (c) Poor preventive practices were compounded by a consensus that malaria prevention was the government's responsibility, and that this reduced motivation for personal prevention. (d) Participants confused the purpose of space-spraying. (e) Participants' responses also exposed persisting misconceptions, mainly concerning the cause of malaria and best practices for its prevention.
CONCLUSION
To eliminate malaria from the Americas, region-specific strategies need to be developed that take into account the local social and cultural contexts. In Loreto, further research is needed to explore the potential shift in biting behaviour of Anopheles darlingi, and how this interacts with the population's social behaviours and current use of preventive measures. Attitudes concerning personal responsibility for malaria prevention and long-standing misconceptions as to the cause of malaria and best preventive practices also need to be addressed.
背景
在秘鲁，尽管几十年来一直集中精力进行控制工作，但疟疾仍然是一个重大的公共卫生负担。秘鲁最近疟疾发病率急剧上升，阻碍了南美洲消除疟疾的进展。亚马逊流域，特别是秘鲁的洛雷托地区，已被确定为实施强化控制战略以实现消除疟疾目标的重点地区。尽管在其他地方控制蚊子非常有效地降低了疟疾的传播，但以前针对洛雷托地区的蚊子控制策略为何收效甚微，还没有研究对此进行解释。本研究采用定性方法探讨了限制该地区蚊子控制策略成功的因素。
方法
在秘鲁伊基托斯的一个初级保健中心，对 20 名成年参与者进行了半结构式访谈，并对 3 名关键信息提供者（医疗保健专业人员）进行了 3 次访谈。访谈重点关注当地知识以及社会和文化态度如何决定蚊子控制方法的使用。
结果
出现了五个主题。（a）参与者认为疟疾是他们文化的一部分，因此普遍认为缺乏预防意识。（b）他们认为蚊子叮咬时间转移到傍晚，使夜间使用蚊帐的效果降低。（c）不良的预防措施因一种共识而加剧，即预防疟疾是政府的责任，这降低了个人预防的动机。（d）参与者混淆了空间喷洒的目的。（e）参与者的反应还暴露了一些持久的误解，主要是关于疟疾的原因和预防疟疾的最佳做法。
结论
为了从美洲消除疟疾，需要制定针对特定地区的策略，考虑到当地的社会和文化背景。在洛雷托，需要进一步研究安第斯疟蚊叮咬行为的潜在变化，以及这种变化如何与人口的社会行为和当前预防措施的使用相互作用。还需要解决个人对预防疟疾的责任、对疟疾的原因和最佳预防措施的长期误解等态度问题。
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