Lubanga R G, Norman S, Ewbank D, Karamagi C
Clinical Epidemiology Unit, Makerere University, Kampala, Uganda.
Acta Trop. 1997 Oct 14;68(1):53-64. doi: 10.1016/s0001-706x(97)00071-5.
A mother's ability to suspect malaria in the presence of fever has important consequences for child survival in malaria-endemic areas. This paper presents results of a clinic-based study of mothers' abilities to suspect malaria in the event of recognizing fever and other physiological and behavioral changes associated with the disease. The study population consisted of all (439) women or mothers who had accompanied children 5 years and below to the Old Mulago Hospital, Kampala, Uganda over a 10 day period during the malaria season of 1992. The children were those who had fever as a major complaint at the time of the visit or those who had fever in the last 7 days and were visiting the clinic for the first time for the current illness. The children were physically examined and their blood tested for malaria parasites. Mothers' diagnosis was compared with clinical and laboratory diagnosis of malaria. Mothers associated the presence of fever with several types of illness and malaria was often not suspected. Only 40% of the mothers suspected malaria in their children. The mothers were poor at recognizing malaria when, in fact, it was present. The sensitivity of the mothers' diagnosis of malaria was found to be 37%; 63% of malaria cases were misclassified as other conditions. The doctors classified most (92%) of the cases presenting with fever as having malaria, but laboratory tests indicated that only 64% of the children really had malaria. The sensitivity of clinical diagnosis was 98%, but the specificity was only 18%. Ninety percent of the mothers gave some medicines before visiting the health centre; and, of these, 76% gave modern drugs exclusively, including antimalarials, antipyretics, antibiotics and other drugs. Among the modern drugs given to children suspected of having malaria, 50% were antimalarials. The most commonly used antimalarial was chloroquine tablets. Mothers indiscriminately administered antimalarials to children irrespective of the perceived cause of the fever. There is need to educate mothers to suspect malaria first in every case of febrile illness, just like the doctors do, and about the first line drugs for the treatment of malaria.
在疟疾流行地区，母亲在孩子发烧时怀疑疟疾的能力对儿童生存具有重要影响。本文介绍了一项基于诊所的研究结果，该研究旨在了解母亲在识别发烧以及与该疾病相关的其他生理和行为变化时怀疑疟疾的能力。研究对象包括1992年疟疾季节期间，在10天内陪同5岁及以下儿童前往乌干达坎帕拉老穆拉戈医院的所有（439名）女性或母亲。这些儿童是在就诊时以发烧为主要症状的，或者是在过去7天内发烧且因当前疾病首次到诊所就诊的。对这些儿童进行了体格检查，并对他们的血液进行了疟原虫检测。将母亲的诊断与疟疾的临床和实验室诊断进行了比较。母亲们将发烧与多种疾病联系起来，常常没有怀疑是疟疾。只有40%的母亲怀疑自己孩子患了疟疾。实际上存在疟疾时，母亲们很难识别出来。发现母亲对疟疾诊断的敏感性为37%；63%的疟疾病例被误诊为其他病症。医生将大多数（92%）发烧病例归类为患有疟疾，但实验室检测表明，只有64%的儿童真的患有疟疾。临床诊断的敏感性为98%，但特异性仅为18%。90%的母亲在前往健康中心之前给孩子服用了一些药物；其中，76%只给孩子服用了现代药物，包括抗疟药、退烧药、抗生素和其他药物。在给疑似患疟疾的儿童服用的现代药物中，50%是抗疟药。最常用的抗疟药是氯喹片。母亲们不顾发烧的可能原因，不加区分地给孩子服用抗疟药。有必要教育母亲们，在每一例发热疾病中都要像医生那样首先怀疑疟疾，并了解治疗疟疾的一线药物。
