布基纳法索农村地区严重发热疾病患儿的家庭费用和治疗时间：直肠青蒿琥酯的作用。

Household costs and time to treatment for children with severe febrile illness in rural Burkina Faso: the role of rectal artesunate.

机构信息

Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

出版信息

Malar J. 2018 Oct 22;17(1):380. doi: 10.1186/s12936-018-2526-8.

DOI:10.1186/s12936-018-2526-8

PMID:30348157

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6198525/

Abstract

BACKGROUND

Community health workers (CHWs) were trained to identify children with malaria who could not take oral medication, treat them with rectal artesunate (RA) and refer them to the closest healthcare facility to complete management. However, many children with such symptoms did not seek CHWs' care. The hypothesis was that the cost of referral to a health facility was a deterrent. The goal of this study was to compare the out-of-pocket costs and time to seek treatment for children who sought CHW care (and received RA) versus those who did not.

METHODS

Children with symptoms of severe malaria receiving RA at CHWs and children with comparable disease symptoms who did not go to a CHW were identified and their parents were interviewed. Household out-of-pocket costs per illness episode and speed of treatment were evaluated and compared between RA-treated children vs. non-RA treated children and by central nervous symptoms (CNS: repeated convulsions, altered consciousness or coma).

RESULTS

Among children with CNS symptoms, costs of RA-treated children were similar to those of non-RA treated children ($5.83 vs. $4.65; p = 0.52), despite higher transport costs ($2.74 vs. $0.91; p < 0.0001). However, among children without CNS symptoms, costs of RA-treated children were higher than the costs of non-RA treated children with similar symptoms ($5.62 vs. $2.59; p = 0.0001), and the main driver of the cost difference was transport. After illness onset, CNS children reached CHWs for RA an average of 9.0 h vs. 16.1 h for non-RA treated children reaching first treatment [difference 7.1 h (95% CI - 1.8 to 16.1), p = 0.11]. For non-CNS patients the average time to CHW-delivered RA treatment was 12.2 h vs. 20.1 h for those reaching first treatment [difference 7.9 h (95% CI 0.2-15.6), p = 0.04]. More non-RA treated children developed CNS symptoms before arrival at the health centre but the difference was not statistically significant (6% vs. 4%; p = 0.58).

CONCLUSIONS

Community health worker-delivered RA does not affect the total out-of-pocket costs when used in children with CNS symptoms, but is associated with higher total out-of-pocket costs when used in children with less severe symptoms. RA-treated children sought treatment more quickly.

摘要

背景

社区卫生工作者（CHWs）接受培训，以识别无法口服药物的疟疾儿童，并用直肠青蒿琥酯（RA）治疗他们，并将他们转介到最近的医疗机构完成管理。然而，许多有此类症状的儿童并未寻求 CHW 的护理。假设转诊到医疗机构的费用是一个障碍。本研究的目的是比较接受 CHW 护理（并接受 RA）的儿童与未接受 CHW 护理的儿童的自付费用和治疗时间。

方法

在 CHW 处接受 RA 治疗的有严重疟疾症状的儿童和有类似疾病症状但未去 CHW 的儿童被确定，并对其父母进行了访谈。评估并比较了每个疾病发作的家庭自付费用和治疗速度，并比较了接受 RA 治疗的儿童与未接受 RA 治疗的儿童以及有中枢神经系统症状（CNS：反复惊厥、意识改变或昏迷）的儿童。

结果

在有 CNS 症状的儿童中，RA 治疗组儿童的费用与未接受 RA 治疗组儿童的费用相似（$5.83 vs. $4.65；p=0.52），尽管交通费用较高（$2.74 vs. $0.91；p<0.0001）。然而，在没有 CNS 症状的儿童中，接受 RA 治疗的儿童的费用高于有类似症状但未接受 RA 治疗的儿童（$5.62 vs. $2.59；p=0.0001），费用差异的主要驱动因素是交通。发病后，CNS 儿童平均在 9.0 小时到达 CHW 接受 RA 治疗，而非 RA 治疗组儿童到达首诊的平均时间为 16.1 小时[差异 7.1 小时（95%CI-1.8 至 16.1），p=0.11]。对于非 CNS 患者，接受 CHW 提供的 RA 治疗的平均时间为 12.2 小时，而到达首诊的平均时间为 20.1 小时[差异 7.9 小时（95%CI0.2 至 15.6），p=0.04]。更多未接受 RA 治疗的儿童在到达医疗中心之前出现了 CNS 症状，但差异无统计学意义（6% vs. 4%；p=0.58）。