乌干达西南部农村地区五岁以下儿童疟疾、腹泻和肺炎患者及时向乡村卫生工作者寻求治疗的情况。

Promptness in seeking treatment from Village Health workers for children under five years with malaria, diarrhoea and pneumonia in rural southwestern Uganda.

机构信息

Department of Community Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.

Bugoye Community Health Collaboration, P.O. Box 149, Kasese, Uganda.

出版信息

Malar J. 2023 Jun 27;22(1):198. doi: 10.1186/s12936-023-04633-z.

DOI:10.1186/s12936-023-04633-z

PMID:37370073

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10294330/

Abstract

BACKGROUND

Village Health Workers (VHWs) in Uganda provide treatment for the childhood illness of malaria, pneumonia, and diarrhoea through the integrated community case management (iCCM) strategy. Under the strategy children under five years receive treatment for these illnesses within 24 h of onset of illness. This study examined promptness in seeking treatment from VHWs by children under five years with malaria, pneumonia, and diarrhoea in rural southwestern Uganda.

METHODS

In August 2022, a database containing information from the VHWs patient registers over a 5-year study period was reviewed (2014-2018). A total of 18,430 child records drawn from 8 villages of Bugoye sub-county, Kasese district were included in the study. Promptness was defined a caregiver seeking treatment for a child from a VHW within 24 h of onset of illness.

RESULTS

Sixty-four percent (64%) of the children included in the study sought treatment promptly. Children with fever had the highest likelihood of seeking prompt treatment (aOR = 1.93, 95% CI 1.80-2.06, p < 0.001) as compared to those with diarrhoea (aOR = 1.43, 95% CI 1.32-1.52, p < 0.001) and pneumonia (aOR = 1.33, 95% CI 1.24-1.42, p < 0.001).

CONCLUSION

The findings provide further evidence that VHWs play a critical role in the treatment of childhood illness in rural contexts. However, the proportion of children seeking prompt treatment remains below the target set at the inception of the iCCM strategy, in Uganda. There is a need to continually engage rural communities to promote modification of health-seeking behaviour, particularly for children with danger signs. Evidence to inform the design of services and behaviour change communication, can be provided through undertaking qualitative studies to understand the underlying reasons for decisions about care-seeking in rural settings. Co-design with communities in these settings may increase the acceptability of these services.

摘要

背景

在乌干达，乡村卫生工作者（VHW）通过综合社区病例管理（iCCM）策略为儿童提供疟疾、肺炎和腹泻治疗。根据该策略，五岁以下儿童在发病后 24 小时内接受这些疾病的治疗。本研究调查了乌干达西南部农村地区五岁以下儿童患疟疾、肺炎和腹泻时向 VHW 寻求治疗的及时性。

方法

2022 年 8 月，对 VHW 患者登记册中包含五年研究期间信息的数据库进行了回顾（2014-2018 年）。来自卡塞塞区布戈耶县 8 个村庄的 18430 名儿童记录被纳入研究。及时性定义为在疾病发作后 24 小时内照顾者向 VHW 寻求治疗。

结果

研究中纳入的 64%（64%）儿童及时寻求治疗。发热儿童最有可能寻求及时治疗（aOR=1.93，95%CI 1.80-2.06，p<0.001），而腹泻（aOR=1.43，95%CI 1.32-1.52，p<0.001）和肺炎（aOR=1.33，95%CI 1.24-1.42，p<0.001）儿童则不然。

结论

这些发现进一步证明，VHW 在农村地区儿童疾病治疗中发挥着关键作用。然而，在乌干达 iCCM 策略启动时设定的目标下，寻求及时治疗的儿童比例仍然较低。需要不断与农村社区接触，以促进改变卫生服务寻求行为，特别是对有危险迹象的儿童。通过开展定性研究来了解农村环境中护理决策的潜在原因，可以提供证据来为服务设计和行为改变传播提供信息。与这些环境中的社区共同设计可能会提高这些服务的可接受性。