系统、供应品和人员：2015 年肯尼亚大规模全国霍乱疫情期间医护人员的经历和卫生机构准备情况的混合方法研究。
Systems, supplies, and staff: a mixed-methods study of health care workers' experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015.
机构信息
US Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA, 30329, USA.
Safe Water and AIDS Project, Kisumu, Kenya.
出版信息
BMC Public Health. 2018 Jun 11;18(1):723. doi: 10.1186/s12889-018-5584-5.
BACKGROUND
From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya's 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June-July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers' (HCW) experiences during outbreak response.
METHODS
Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns.
RESULTS
Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs' personal passion to help others.
CONCLUSIONS
The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans.
背景
2014 年 12 月至 2016 年 9 月，肯尼亚发生了自 2010 年以来最大规模的霍乱疫情，报告病例 16840 例，死亡 256 例。疫情波及肯尼亚 47 个县中的 30 个县，而此时许多医疗服务已下放到县级。本项 2015 年 6 月至 7 月开展的混合方法研究评估了霍马贝、内罗毕和蒙巴萨县的霍乱防备情况，并探讨了诊所和社区卫生保健工作者（HCW）在疫情应对期间的经验。
方法
根据累计霍乱负担和地理特征选择了各县。我们进行了 44 次卫生机构霍乱防备情况检查表（根据国家指南）和 8 次焦点小组讨论（FGD）。生成了防备检查表的频率。为了从 FGD 中确定关键主题，我们应用了归纳和演绎代码；使用 MAX 软件（MAXQDA）进行定性数据分析，以识别模式。
结果
一些医疗机构缺乏治疗霍乱患者、诊断病例和维持感染控制所需的关键材料。总体而言，82%（36/44）的卫生机构有口服补液盐，65%（28/43）有静脉输液，27%（12/44）有直肠拭子，11%（5/44）有 Cary-Blair 运输培养基，86%（38/44）有手套。相当多的医疗机构缺乏疾病报告表（34%，14/41）和霍乱治疗指南（37%，16/43）。在 FGD 中，HCW 描述了在疫情期间对角色和报告的困惑，这突显了卫生系统内协调和管理结构方面的问题。与检查表的结果相似，FGD 参与者描述了影响实验室准备和感染预防与控制的供应挑战。认为成功的因素包括社区参与、健康教育、诊所和社区 HCW 之间的强有力合作，以及 HCW 帮助他人的个人热情。
结论
本评价中发现的角色、报告和管理方面的混乱，凸显了需要在县级层面调整、实施和交流卫生战略，以便在卫生系统转型期间为 HCW 提供信息和培训。国际、国家和县级利益攸关方可以通过进一步投资于现有的综合疾病监测和反应结构以及国家霍乱预防和控制计划，并采用具体的县级霍乱控制计划，加强肯尼亚的霍乱和其他突发公共卫生事件的防备和应对工作，从而加强全球卫生安全。
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