National Malaria Control Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.
The International Union of Tuberculosis and Lung Diseases, Union South-East Asia Regional Office, New Delhi, India.
Malar J. 2018 Jun 20;17(1):242. doi: 10.1186/s12936-018-2384-4.
Malaria is one of the major public health problems in Myanmar. Village health volunteers (VHV) are the key malaria diagnosis and treatment service provider at community level in addition to basic health staffs (BHS). This countrywide analysis aimed to assess and compare the accessibility to- and quality of malaria care (treatment initiation, treatment within 24 h and complete treatment delivery) between VHV and BHS in Myanmar.
This was a retrospective cohort study using record review of routinely collected programme data available in electronic format. All patients with undifferentiated fever screened and diagnosed for malaria in January-December 2015 by VHV and BHS under National Malaria Control Programme in Myanmar were included in the study. Unadjusted and adjusted prevalence ratios (aPR) were calculated to assess the effect of VHV/BHS on receipt of treatment by patients.
Of 978,735 undifferentiated fever patients screened in 2015, 11.0% of patients were found malaria positive and the malaria positivity in VHV and BHS group were 11.1 and 10.9% respectively. Access to malaria care: higher proportion of children aged 5-14 years (21.8% vs 17.3%) and females (43.7% vs 41.8%) with fever were screened for malaria by VHV compared to BHS. However, the same for children aged < 5 years was 2.2% lower in VHV group compared to BHS. Quality of malaria care: the proportion of malaria cases that received treatment was 96.6 and 94.9; treatment initiation within 24 h of fever was 44.7 and 34.1; and, complete treatment delivery was 80.9 and 88.2, respectively, in VHV and BHS groups. After adjustment for potential confounders, patients with malaria provided care by VHV had 1.02 times higher chance of receiving treatment compared to BHS [aPR (95% confidence interval) 1.017 (1.015, 1.020)].
The VHV were more accessible to children and women than BHS in providing malaria screening services. The malaria treatment services provided by VHV was as good as BHS. Further qualitative research to explore and address the challenges on initiation and delivering complete treatment by VHV including inventory assessment and cost-effectiveness studies on integration of VHV in routine health system are needed.
疟疾是缅甸主要的公共卫生问题之一。除了基本卫生工作人员（BHS）之外，乡村卫生志愿者（VHV）还是社区一级疟疾诊断和治疗服务的主要提供者。本项全国性分析旨在评估和比较 VHV 和 BHS 在提供疟疾护理（治疗开始、24 小时内治疗和完全治疗交付）方面的可及性和质量。
这是一项使用记录回顾的回顾性队列研究，使用电子格式提供的常规收集计划数据。2015 年 1 月至 12 月期间，国家疟疾控制计划下的 VHV 和 BHS 在缅甸对所有不明原因发热患者进行筛查和诊断为疟疾的患者均纳入本研究。未调整和调整后的患病率比（aPR）用于评估 VHV/BHS 对患者接受治疗的影响。
2015 年筛查的 978735 名不明原因发热患者中，11.0%的患者疟原虫检测呈阳性，VHV 和 BHS 组的疟原虫阳性率分别为 11.1%和 10.9%。获得疟疾护理的机会：VHV 组筛查发热的 5-14 岁儿童（21.8%对 17.3%）和女性（43.7%对 41.8%）比例较高。然而，VHV 组 5 岁以下儿童的筛查比例比 BHS 低 2.2%。疟疾护理质量：接受治疗的疟疾病例比例分别为 VHV 组 96.6%和 BHS 组 94.9%；发热后 24 小时内开始治疗的比例分别为 VHV 组 44.7%和 BHS 组 34.1%；完全治疗交付的比例分别为 VHV 组 80.9%和 BHS 组 88.2%。在调整潜在混杂因素后，VHV 组疟疾病例接受治疗的可能性比 BHS 组高 1.02 倍[aPR（95%置信区间）为 1.017（1.015，1.020）]。
与 BHS 相比，VHV 更便于儿童和妇女接受疟疾筛查服务。VHV 提供的疟疾治疗服务与 BHS 一样好。需要进一步进行定性研究，以探索和解决 VHV 在启动和提供完全治疗方面的挑战，包括库存评估和将 VHV 纳入常规卫生系统的成本效益研究。
