传统治疗师在埃塞俄比亚牧民社区发现活动性肺结核病例中的作用：一项试点干预研究。
Traditional healers' role in the detection of active tuberculosis cases in a pastoralist community in Ethiopia: a pilot interventional study.
机构信息
Department of Health Education and Behavioural Science, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia.
Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway.
出版信息
BMC Public Health. 2019 Jun 10;19(1):721. doi: 10.1186/s12889-019-7074-9.
BACKGROUND
Pastoralists rely on traditional healers (THs) for general health problems. However, some studies indicate that such practices result in delays in the diagnosis and treatment of tuberculosis (TB) cases. This study aims to assess the role of traditional healers in the detection and referral of active TB cases in a pastoralist community.
METHODS
We identified 22 traditional healers from 7 villages of Kereyu pastoralist community in the Fentale district in Ethiopia in January 2015. We trained these THs in identifying presumptive TB symptoms and early referral to the nearby healthcare facilities. The training was held during a 1 week period that included a visit to their villages and follow-up. A 1 day meeting was held with the traditional healers, the district TB care and prevention coordinator and health extension workers from the selected sub-district to discuss the referral link between THs and the nearby healthcare facilities. Health providers working at the TB units in the selected healthcare facilities were oriented about the training given and planned involvement of THs in referring presumptive TB case. In addition, documentation of the presumptive TB cases was discussed.
RESULTS
We succeeded in tracing and interviewing 8 of the 22 THs. The rest were on seasonal migration. According to the THs report for the 1 year period, these 8 THs had referred 24 TB suspects to the healthcare facilities. Sputum smear microscopy confirmed 13 of the 24 suspects as having TB cases. Among those confirmed, 10 completed treatment and three were on treatment. Five presumptive TB cases were confirmed non TB cases through further evaluation at the healthcare facilities and six of the presumptive TB cases were lost to follow up by the THs. Whereas, four of the presumptive TB cases were lost to follow up to the healthcare facility.
CONCLUSIONS
Results of the present study indicate that THs can contribute to the detection of undiagnosed active TB cases in a pastoralist community, provided they are given appropriate training and support.
背景
牧民通常依靠传统治疗师（THs）来解决一般健康问题。然而，一些研究表明，这种做法会导致结核病（TB）病例的诊断和治疗延迟。本研究旨在评估传统治疗师在牧民社区中发现和转诊活动性肺结核病例中的作用。
方法
我们于 2015 年 1 月在埃塞俄比亚芬塔勒区的 Kereyu 牧民社区的 7 个村庄中确定了 22 名传统治疗师。我们培训这些 THs 识别疑似结核病症状并及早转介到附近的医疗机构。培训为期 1 周，包括到他们的村庄进行访问和随访。与传统治疗师、地区结核病护理和预防协调员以及选定分区的卫生推广工作者举行了为期 1 天的会议，讨论传统治疗师与附近医疗机构之间的转诊联系。选定医疗保健设施中的结核病单位的卫生工作者了解了所提供的培训以及计划让传统治疗师参与转诊疑似结核病病例。此外，还讨论了疑似结核病病例的记录。
结果
我们成功追踪并采访了 22 名 THs 中的 8 名。其余的人正在季节性迁移。根据 THs 在过去 1 年中的报告，这 8 名 THs 将 24 名疑似结核病患者转诊到了医疗机构。24 名疑似患者中有 13 名经痰涂片显微镜检查证实患有结核病。在确诊的病例中，有 10 人完成了治疗，有 3 人正在接受治疗。5 例疑似结核病病例在医疗机构进一步评估后被确诊为非结核病病例，6 例疑似结核病病例被 THs 失访。而 4 例疑似结核病病例则失访到医疗机构。
结论
本研究结果表明，只要给予适当的培训和支持，传统治疗师就可以为发现牧民社区中未经诊断的活动性结核病病例做出贡献。
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