Tsukahara Takahiro, Sugahara Takuma, Furusawa Takuro, Hombhanje Francis Wanak
Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Graduate School of Economics, Hosei University, Tokyo, Japan.
Front Public Health. 2018 Mar 13;6:75. doi: 10.3389/fpubh.2018.00075. eCollection 2018.
In Papua New Guinea (PNG), a malaria treatment policy using rapid diagnostic tests (RDTs) plus artemisinin-based combination therapy (ACT) was widely introduced to rural communities in 2012. The objectives of the study were to evaluate the effect of this RDT/ACT introduction to a rural PNG population on health service utilization and to compare factors associated with health service utilization before and after the RDT/ACT introduction.
Household surveys with structured questionnaires were conducted before and after the introduction of RDT/ACT in a catchment area of a health center in East Sepik Province, PNG. We interviewed caregivers with children less than 15 years of age and collected data on fever episodes in the preceding 2 weeks. Using propensity score matching, febrile children before the introduction of RDT/ACT were matched to febrile children after the introduction. Then, the adjusted difference in the proportion of health service utilization [i.e., the average treatment effect (ATE) of the introduction of RDT/ACT on health service utilization] was estimated. We also employed a multilevel Poisson regression model to investigate factors influencing the use of health services.
Of 4,690 children, 911 (19%) were reported to have a fever episode. The unadjusted proportion of health service utilization was 51.7 and 57.2% before and after the RDT/ACT introduction, respectively. After matching, no significant difference in the health service utilization was observed before and after the introduction of RDT/ACT (ATE: 0.063, 95% confidence interval -0.024 to 0.150). Multilevel regression analysis showed that the consistent factors associated with a higher utilization of health services were severe illness and being female.
The utilization of health services was not significantly different before and after the introduction of RDT/ACT. Villagers may have neither sufficient informations on the new protocol nor high acceptance of RDT/ACT. The observed gender bias in health service utilization could be due to female caregivers' preferences toward girls.
2012年，巴布亚新几内亚（PNG）广泛向农村社区推行了一项使用快速诊断检测（RDT）加青蒿素类复方疗法（ACT）的疟疾治疗政策。本研究的目的是评估在巴布亚新几内亚农村人群中引入这种RDT/ACT对卫生服务利用的影响，并比较RDT/ACT引入前后与卫生服务利用相关的因素。
在巴布亚新几内亚东塞皮克省一个卫生中心的集水区，于引入RDT/ACT之前和之后进行了采用结构化问卷的家庭调查。我们采访了有15岁以下儿童的照料者，并收集了前两周内发热发作的数据。采用倾向得分匹配法，将引入RDT/ACT之前的发热儿童与引入之后的发热儿童进行匹配。然后，估计卫生服务利用比例的调整差异[即引入RDT/ACT对卫生服务利用的平均治疗效果（ATE）]。我们还采用了多水平泊松回归模型来研究影响卫生服务使用的因素。
在4690名儿童中，有911名（19%）报告有发热发作。引入RDT/ACT之前和之后，卫生服务利用的未调整比例分别为51.7%和57.2%。匹配之后，引入RDT/ACT之前和之后的卫生服务利用情况未观察到显著差异（ATE：0.063，95%置信区间为-0.024至0.150）。多水平回归分析表明，与较高卫生服务利用率相关的一致因素是重病和女性。
引入RDT/ACT之前和之后，卫生服务利用情况没有显著差异。村民可能既没有关于新方案的足够信息，对RDT/ACT的接受度也不高。在卫生服务利用中观察到的性别偏见可能是由于女性照料者对女孩的偏好。
