Ibrahim S, Isani Z
National Institute of Child Health, Karachi.
J Pak Med Assoc. 1997 Jan;47(1):7-11.
Diarrhoeal diseases are a major contributory factor for high infant mortality and morbidity in Pakistan. To overcome this, Government of Pakistan launched a National Programme for Control of Diarrhoeal Disease. A Diarrhoea Training Unit (DTU) was established at the National Institute of Child Health, Karachi, where apart from proper case management, 17 training workshops were held between July, 1989 to July, 1991. Eighty-five doctors from various facilities in Sindh were trained in proper management of diarrhoea and establishment of Oral Rehydration Therapy (ORT) units in their regions. Evaluation of DTU training, assessment of the knowledge of trained doctors, case management and function of ORT Units were done between September, 1992 and October, 1993. Two teams each consisting of a doctor and a lady health visitor, visited 30 such facilities. An observation check list was used for assessing the ORT unit and diarrhoea case management and a test questionnaire for the knowledge of facility physician and paramedic. Of the 29 facilities, 17 had DTU trained doctors. ORT corner had been established in 26, weighing scales were used in 21, record keeping in eight and soap and water was available for hand washing in seven centres. The presence of untrained doctors provided an opportunity to compare the two groups. Dehydration assessment was fairly good, weight was recorded in fewer cases than desirable, case management was similar in the two groups, except for infrequent use of antibiotics by the trained group. Prevention was poorly advised. Physicians' knowledge in both groups was similar but deficient in advising the use of ORS, feeding in diarrhoea and nutritional assessment. The trained ones had significantly better knowledge about drugs and this was reflected in their case management. Paramedic case management were similar to those in doctors. The study thus showed positive and beneficial effects of training.
腹泻病是巴基斯坦婴儿高死亡率和高发病率的一个主要促成因素。为克服这一问题，巴基斯坦政府发起了一项控制腹泻病国家计划。在卡拉奇的国家儿童健康研究所设立了一个腹泻病培训股，除了进行适当的病例管理外，在1989年7月至1991年7月期间还举办了17期培训班。来自信德省各医疗机构的85名医生接受了腹泻病妥善管理以及在其所在地区建立口服补液疗法（ORT）单位的培训。在1992年9月至1993年10月期间对腹泻病培训股的培训情况、对受训医生的知识评估、病例管理以及ORT单位的功能进行了评估。两个小组，每个小组由一名医生和一名女保健访视员组成，走访了30个这样的医疗机构。使用一份观察检查表来评估ORT单位和腹泻病例管理情况，并使用一份测试问卷来评估医疗机构医生和辅助医务人员的知识。在29个医疗机构中，17个有接受过腹泻病培训股培训的医生。26个机构设立了ORT角，21个机构使用了体重秤，8个机构有记录保存，7个中心有肥皂和水用于洗手。未受过培训的医生的存在提供了比较两组的机会。脱水评估相当不错，体重记录的病例数比理想情况少，两组的病例管理情况相似，只是受训组较少使用抗生素。预防建议不足。两组医生的知识相似，但在建议使用口服补液盐、腹泻时的喂养和营养评估方面存在不足。受过培训的医生对药物的了解明显更好，这在他们的病例管理中得到了体现。辅助医务人员的病例管理与医生的相似。因此，该研究显示了培训的积极和有益效果。
