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坦桑尼亚的蛇伤治疗:发现社区实践和医院资源中的差距。

Snakebite Treatment in Tanzania: Identifying Gaps in Community Practices and Hospital Resources.

机构信息

Heidelberg Institute for Global Health (HIGH), Heidelberg University, 69117 Heidelberg, Germany.

School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania.

出版信息

Int J Environ Res Public Health. 2022 Apr 13;19(8):4701. doi: 10.3390/ijerph19084701.

Abstract

Snakebite envenoming causes more than 140,000 deaths annually and at least triple this number of disabilities. The World Health Organization classified snakebite as a Neglected Tropical Disease in 2017 and developed a strategy to halve death and disability from snakebite by 2030. To achieve this goal, snakebite victims need to receive safe and effective treatment. This descriptive, cross-sectional study surveyed student health professionals (N = 312) in Dar es Salaam, Tanzania, and was designed to identify major gaps in community practices and hospital resources for snakebite treatment. Participants reported using traditional community practices (44%, 95% confidence interval (CI) = 39-50%), allopathic practices (7%, 95% CI = 5-11%), or a combination of both (49%, 95% CI = 43-54%) to treat snakebite. Harmful practices included tight arterial tourniquets (46%, 95% CI = 41-52%) and wound incisions (15%, 95% CI = 11-19%). Many participants (35%, 95% CI = 29-40%) also turned to traditional healers. Students who treated snakebite injuries within the last 5 years (N = 69) also reported their general experiences with snakebite in hospitals. Hospitals often lacked essential resources to treat snakebite victims, and 44% (95% CI = 30-59%) of snakebite victims arrived at a hospital only three or more hours after the bite. A significant percentage of snakebite victims experienced lasting damage (32%, 95% CI = 20-47%) or death (14%, 95% CI = 7-25%). Snakebite outcomes could likely be improved if hospitals were universally and consistently equipped with the essential resources to treat snakebite victims, such as antivenoms. Educational interventions aimed at communities should focus on discouraging tourniquet use and tampering with the wound. Collaboration between the allopathic and traditional health system could further boost snakebite outcomes because traditional healers are often the first health workers to see snakebite victims.

摘要

全球每年有超过 14 万人死于蛇伤,至少有三倍于此的人数因此残疾。世界卫生组织于 2017 年将蛇伤列为被忽视的热带病,并制定了一项战略,目标是到 2030 年将因蛇伤导致的死亡和残疾人数减半。为了实现这一目标,蛇伤患者需要接受安全有效的治疗。本研究采用描述性、横断面设计,对坦桑尼亚达累斯萨拉姆的学生健康专业人员(N=312)进行了调查,旨在确定社区实践和医院蛇伤治疗资源方面的主要差距。参与者报告使用传统社区实践(44%,95%置信区间[CI]:39-50%)、对抗疗法实践(7%,95%CI:5-11%)或两者的组合(49%,95%CI:43-54%)来治疗蛇伤。有害做法包括使用紧绷的动脉止血带(46%,95%CI:41-52%)和伤口切开(15%,95%CI:11-19%)。许多参与者(35%,95%CI:29-40%)还求助于传统治疗师。在过去 5 年内治疗过蛇伤损伤的学生(N=69)还报告了他们在医院治疗蛇伤的一般经验。医院通常缺乏治疗蛇伤患者的基本资源,并且 44%(95%CI:30-59%)的蛇伤患者在咬伤后 3 小时或更长时间才到达医院。相当一部分蛇伤患者遭受了持久的损伤(32%,95%CI:20-47%)或死亡(14%,95%CI:7-25%)。如果医院普遍配备治疗蛇伤患者的基本资源,如抗蛇毒血清,那么蛇伤的结局可能会得到改善。针对社区的教育干预措施应侧重于劝阻使用止血带和干扰伤口。对抗疗法和传统卫生系统之间的合作可以进一步提高蛇伤的结局,因为传统治疗师通常是第一个看到蛇伤患者的卫生工作者。

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