American Leprosy Missions, Greenville, South Carolina United States of America.
Ghana Neglected Tropical Disease Program, Accra, Ghana.
PLoS Negl Trop Dis. 2023 Jun 12;17(6):e0010805. doi: 10.1371/journal.pntd.0010805. eCollection 2023 Jun.
In districts where lymphatic filariasis (LF) is endemic, the goal is to provide 100% geographical coverage of the essential package of care. Additionally, countries seeking elimination status must document the availability of services for lymphoedema and hydrocele in all endemic areas. To do this, the WHO recommends conducting assessments of the readiness and quality of services provided to identify service delivery and quality gaps. This study used the recommended WHO Direct Inspection Protocol (DIP), which consists of 14 core indicators related to LF case management, medicine and commodities, staff knowledge and patient tracking. The survey was administered in 156 health facilities across Ghana designated and trained to provide LF morbidity management services. Patient and health provider interviews were also conducted to assess challenges and feedback.
The highest performing indicators across the 156 surveyed facilities were related to staff knowledge; 96.6% of health workers correctly identified two or more signs and symptoms. The lowest scoring indicators concerned medication availability, with the two lowest scoring indicators in the survey being availability of antifungals (26.28%) and antiseptics (31.41%). Hospitals performed best with an overall score of 79.9%, followed by health centers (73%), clinics (67.1%) and CHPS compounds (66.8%). The most commonly reported challenge from health worker interviews was lack of medications and supplies, followed by a lack of training or poor motivation.
The findings from this study can help the Ghana NTD Program identify areas of improvement as they seek to achieve LF elimination targets and continue to improve access to care for those with LF-related morbidity as part of overall health systems strengthening. Key recommendations include prioritizing refresher and MMDP training for health workers, ensuring reliable patient tracking systems, and integrating lymphatic filariasis morbidity management into the routine healthcare system to ensure medicine and commodity availably.
在淋巴丝虫病（LF）流行的地区，目标是提供基本护理包的 100%地理覆盖范围。此外，寻求消除地位的国家必须记录在所有流行地区提供淋巴水肿和鞘膜积液服务的情况。为此，世界卫生组织（WHO）建议进行服务准备情况和质量评估，以确定服务提供和质量差距。本研究使用了世界卫生组织（WHO）推荐的直接检查协议（DIP），该协议由 14 个与 LF 病例管理、药物和商品、员工知识和患者跟踪相关的核心指标组成。该调查在加纳的 156 个卫生机构进行，这些机构被指定并接受培训，以提供 LF 发病率管理服务。还对患者和卫生提供者进行了访谈，以评估挑战和反馈。
在所调查的 156 个卫生机构中，得分最高的指标与员工知识有关；96.6%的卫生工作者正确识别出两个或更多的体征和症状。得分最低的指标涉及药物供应，调查中得分最低的两个指标是抗真菌药物（26.28%）和防腐剂（31.41%）的供应。医院的总体得分最高，为 79.9%，其次是卫生中心（73%）、诊所（67.1%）和 CHPS 化合物（66.8%）。从卫生工作者访谈中报告的最常见挑战是缺乏药物和用品，其次是缺乏培训或缺乏动力。
本研究的结果可以帮助加纳国家非传染性疾病方案确定改进领域，因为它们力求实现 LF 消除目标，并继续改善与 LF 相关发病率患者的护理机会，作为整体卫生系统加强的一部分。关键建议包括优先为卫生工作者提供复习和 MMDP 培训，确保可靠的患者跟踪系统，并将淋巴丝虫病发病率管理纳入常规医疗保健系统，以确保药物和商品的供应。
