社区对冈比亚消除疟疾无症状感染治疗的看法。
Community perspectives on treating asymptomatic infections for malaria elimination in The Gambia.
机构信息
Medical Anthropology Unit, Institute of Tropical Medicine, Antwerp, Belgium.
Medical Research Council Unit the Gambia at the London, School of Hygiene and Tropical Medicine, Fajara, The Gambia.
出版信息
Malar J. 2019 Feb 18;18(1):39. doi: 10.1186/s12936-019-2672-7.
BACKGROUND
Innovative and cost-effective strategies that clear asymptomatic malaria infections are required to reach malaria elimination goals, but remain a challenge. This mixed methods study explored people's attitudes towards the reactive treatment of compound contacts of malaria cases with a 3-day course of dihydroartemisinin-piperaquine (DHAP), the socio-cultural representations of asymptomatic infections, and more specifically their treatment.
METHODS
Prior to the start of the intervention, a sequential mixed method study was carried out. Qualitative data collection involved in-depth interviews and participant observations (including informal conversations) with key informants from the trial communities and the trial staff. Quantitative data were derived from a pre-trial cross-sectional survey on health literacy and health-seeking behaviour among randomly selected members of the study communities.
RESULTS
In the pre-trial cross-sectional survey, 73% of respondents reported that malaria could be hidden in the body without symptoms. Whilst this may be interpreted as people's comprehension of asymptomatic malaria, qualitative data indicated that informants had different interpretations of asymptomatic disease than the biomedical model. It was described as: (i) a minor illness that does not prevent people carrying out daily activities; (ii) an illness that oscillates between symptomatic and asymptomatic phases; and, (iii) a condition where disease agents are present in the body but remain hidden, without signs and symptoms, until something triggers their manifestation. Furthermore, this form of hidden malaria was reported to be most present in those living in the same compound with a malaria case (71%).
CONCLUSION
Treating asymptomatic malaria with pharmaceuticals was considered acceptable. However, people felt uncertain to take treatment without screening for malaria first, largely due to the lack of symptoms. Knowledge of asymptomatic malaria was not a strong re-inforcement for treatment adherence. In this study, the pre-intervention active engagement of communities existed of having people co-design accurate information messages about their personal risk of malaria, which increased their trust in expert knowledge and thus proved essential for the successful implementation of the community-based intervention.
背景
为了实现消除疟疾的目标，需要创新且具有成本效益的策略来清除无症状疟疾感染，但这仍然是一个挑战。本混合方法研究探讨了人们对疟疾病例的复合接触者进行反应性治疗的态度，使用 3 天疗程的双氢青蒿素-哌喹（DHAP），以及无症状感染的社会文化表现，特别是它们的治疗方法。
方法
在干预开始之前，进行了一项顺序混合方法研究。定性数据收集包括对来自试验社区的关键信息提供者和试验工作人员进行深入访谈和参与观察（包括非正式对话）。定量数据来自于对研究社区中随机选择的成员进行的健康素养和求医行为的预试验横断面调查。
结果
在预试验横断面调查中，73%的受访者报告说疟疾可能在没有症状的情况下隐藏在体内。虽然这可能被解释为人们对无症状疟疾的理解，但定性数据表明，信息提供者对无症状疾病的解释与生物医学模型不同。它被描述为：（i）一种不会阻止人们进行日常活动的轻微疾病；（ii）一种在有症状和无症状之间波动的疾病；和，（iii）一种疾病因子存在于体内但隐藏起来，没有迹象和症状，直到有什么东西触发其表现。此外，据报告，这种隐性疟疾在与疟疾病例居住在同一住所的人（71%）中最为常见。
结论
用药物治疗无症状疟疾被认为是可以接受的。然而，人们认为在没有首先筛查疟疾的情况下就服用治疗药物是不确定的，主要是因为没有症状。对无症状疟疾的了解并没有强烈增强治疗的依从性。在本研究中，社区的预干预主动参与包括让人们共同设计关于他们个人疟疾风险的准确信息信息，这增加了他们对专家知识的信任，因此对成功实施基于社区的干预措施至关重要。
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