在圭亚那内陆地区挖掘金矿工人的求医行为：对疟疾检测和治疗的社会和行为动机进行定性的行动者-非行动者分析。
Digging for care-seeking behaviour among gold miners in the Guyana hinterland: a qualitative doer non-doer analysis of social and behavioural motivations for malaria testing and treatment.
机构信息
Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, USA.
Breakthrough ACTION Guyana, XX Barrack St., Georgetown, Guyana.
出版信息
Malar J. 2020 Jul 6;19(1):235. doi: 10.1186/s12936-020-03289-3.
BACKGROUND
Although Guyana has made significant progress toward malaria control, limited access to malaria testing and treatment services threatens those gains. Mining activities create breeding environments for mosquitoes, and the migrant and mobile mining populations are hard to reach with information and services. The Ministry of Public Health (MoPH) has trained volunteers to test and treat malaria cases in remote regions. However, it remains unclear how miners perceive these testers, the services they provide, or what their malaria care-seeking behaviour is in general. To better address these challenges, Breakthrough ACTION Guyana and MoPH conducted qualitative research from October to November 2018 in Regions 7 and 8 in Guyana.
METHODS
A total of 109 individuals, 70 miners, 17 other mining camp staff, and 22 other key stakeholders (e.g. community health workers, pharmacists, and regional leadership), participated in semi-structured interviews and focus group discussions. Results were derived using a framework analysis, with an adjusted doer and non-doer analysis, and organized using the integrated behaviour framework.
RESULTS
Miners sought MoPH-approved services because of close geographic proximity to testing services, a preference for public service treatment, and a desire to correctly diagnose and cure malaria rather than just treat its symptoms. Those who chose to initiate self-treatment-using unregulated medications from the private and informal sector-did so out of convenience and the belief that self-treatment had worked before. Miners who completed the full MoPH-approved treatment understood the need to complete the treatment, while those who prematurely stopped treatment did so because of medication side effects and a desire to feel better as soon as possible.
CONCLUSION
Reasons why miners do and do not pursue malaria testing and treatment services are diverse. These results can inform better MoPH programming and new solutions to improve malaria outcomes in Guyana.
背景
尽管圭亚那在控制疟疾方面取得了重大进展，但疟疾检测和治疗服务的有限获取威胁到了这些进展。采矿活动为蚊子创造了滋生环境，而流动人口难以获得信息和服务。圭亚那公共卫生部（MoPH）已培训志愿者在偏远地区检测和治疗疟疾病例。然而，矿工对这些检测人员、他们提供的服务以及他们一般的疟疾求医行为的看法尚不清楚。为了更好地应对这些挑战，Breakthrough ACTION Guyana 和 MoPH 于 2018 年 10 月至 11 月在圭亚那的第 7 区和第 8 区开展了定性研究。
方法
共有 109 人参加了半结构式访谈和焦点小组讨论，其中 70 名矿工、17 名其他矿区工作人员和 22 名其他利益攸关方（如社区卫生工作者、药剂师和区域领导）。结果使用框架分析法得出，采用调整后的行动者和非行动者分析，并使用综合行为框架进行组织。
结果
矿工寻求 MoPH 批准的服务，是因为这些服务与检测服务地理位置接近，他们更喜欢公共服务治疗，并且希望正确诊断和治愈疟疾，而不仅仅是治疗症状。那些选择使用私人和非正规部门未经监管的药物进行自我治疗的人，是因为方便，并且相信自我治疗以前有效。那些完成完整 MoPH 批准治疗的矿工理解完成治疗的必要性，而那些提前停止治疗的矿工则是因为药物副作用和希望尽快感觉好转。
结论
矿工是否寻求疟疾检测和治疗服务的原因多种多样。这些结果可以为 MoPH 制定更好的方案和寻找新的解决方案提供信息，以改善圭亚那的疟疾结果。
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