Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda.
BMC Public Health. 2021 Oct 16;21(1):1870. doi: 10.1186/s12889-021-11908-0.
Malaria accounts for more than one-tenth of sub-Saharan Africa's 2.8 million annual childhood deaths, and remains a leading cause of post-neonatal child mortality in Uganda. Despite increased community-based treatment in Uganda, children continue to die because services fail to reach those most at risk. This study explores the influence of two key equity factors, socioeconomic position and rurality, on whether children with fever in eastern Uganda receive timely access to appropriate treatment for suspected malaria.
This was a cross-sectional study in which data were collected from 1094 caregivers of children aged 6-59 months on: illness and care-seeking during the previous two weeks, treatment received, and treatment dosing schedule. Additional data on rurality and household socioeconomic position were extracted from the Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) database. A child was considered to have received prompt and appropriate care for symptoms of malaria if they received the recommended drug in the recommended dosing schedule on the day of symptom onset or the next day. Unadjusted and adjusted logistic regression models were developed to explore associations of the two equity factors with the outcome. The STROBE checklist for observational studies guided reporting.
Seventy-four percent of children had symptoms of illness in the preceding two weeks, of which fever was the most common. Children from rural households were statistically more likely to receive prompt and appropriate treatment with artemisinin-combination therapy than their semi-urban counterparts (OR 2.32, CI 1.17-4.59, p = 0.016). This association remained significant following application of an adjusted regression model that included the age of the child, caregiver relationship, and household wealth index (OR 2.4, p = 0.036). Wealth index in its own right did not exert a significant effect for children with reported fever (OR for wealthiest quintile = 1.02, CI 0.48-2.15, p = 0.958).
The findings from this study help to identify the role and importance of two key equity determinants on care seeking and treatment receipt for fever in children. Whilst results should be interpreted within the limitations of data and context, further studies have the potential to assist policy makers to target inequitable social and spatial variations in health outcomes as a key strategy in ending preventable child morbidity and mortality.
疟疾导致撒哈拉以南非洲地区每年 280 万儿童死亡的比例超过十分之一，在乌干达仍是导致新生儿后儿童死亡的主要原因。尽管乌干达社区基础治疗有所增加，但由于服务无法覆盖到最危险的人群，儿童仍在死亡。本研究旨在探讨两个关键的公平因素（社会经济地位和农村地区）对乌干达东部发热儿童是否能及时获得疑似疟疾的适当治疗的影响。
这是一项横断面研究，从 1094 名 6-59 月龄儿童的看护者那里收集了以下数据：在过去两周内的疾病和求医情况、接受的治疗以及治疗剂量方案。从 Iganga-Mayuge 健康和人口监测站点（HDSS）数据库中提取了关于农村地区和家庭社会经济地位的其他数据。如果儿童在症状出现当天或次日接受了推荐药物的推荐剂量方案，则认为其获得了及时和适当的疟疾症状治疗。采用未调整和调整后的逻辑回归模型来探讨这两个公平因素与结果之间的关联。本研究遵循 STROBE 观察性研究报告规范。
74%的儿童在过去两周内出现了疾病症状，其中发热最为常见。来自农村家庭的儿童接受青蒿素联合疗法的及时和适当治疗的可能性明显高于半城市家庭（比值比 2.32，95%置信区间 1.17-4.59，p=0.016）。在应用包括儿童年龄、看护者关系和家庭财富指数的调整回归模型后，这种关联仍然显著（比值比 2.4，p=0.036）。就自身而言，财富指数对有发热报告的儿童没有显著影响（最富裕五分位数的比值比=1.02，95%置信区间 0.48-2.15，p=0.958）。
本研究的结果有助于确定两个关键公平决定因素在儿童发热时寻求医疗和接受治疗方面的作用和重要性。虽然结果应在数据和背景的限制范围内进行解释，但进一步的研究有可能帮助决策者将不平等的社会和空间健康结果差异作为结束可预防儿童发病和死亡的关键战略。
