Kirigia J M
Department of Community Health, University of Cape Town, South Africa.
Health Econ. 1998 Sep;7(6):551-6. doi: 10.1002/(sici)1099-1050(199809)7:6<551::aid-hec367>3.0.co;2-7.
Poor countries can ill-afford ineffective health care. An effective disease intervention is one which produces a net improvement in beneficiaries' quality of life and/or increases life expectancy. Unlike developed countries, very little research has been done in developing countries on the measures of the ultimate output of health care. The objectives of this study were to: (i) apply the existing health-related quality of life (HRQoL) methods in eliciting health state valuations from farmers, teachers and health professionals living and working in the schistosomiasis endemic Mwea Irrigation Scheme in Kenya; (ii) determine whether there is significant difference between average health states valuations from the three main groups of people at risk of schistosomiasis infection; and (iii) assess the relative effect of different respondent characteristics and health states prognosis on valuations. The instrument consists of seven health state descriptions-each defined along six functional dimensions: self-care, mobility, livelihood activities, energy, social participation and pain. Cardinal health state values were measured using a visual-analogue-scale (VAS). Values were elicited from three random samples of farming general public, medical professionals and teachers. The Kruskal-Wallis one-way ANOVA test showed that there is significant difference in the average health state values (for mild, moderate, severe, very severe and comatose states) obtained from the three samples. Generally, except for the valuation of the immediately following state, the other explanatory variables are not statistically significant determinants of valuations for the mild, moderate, severe and very severe states. The results suggest that VAS valuations are primarily affected by prognosis. There is urgent need for more representative and systematic HRQoL studies to test the relevance of the Western-based generic instruments in African countries contexts, with a view to developing more appropriate tool(s) if necessary.
贫穷国家根本无力承担无效的医疗保健。有效的疾病干预措施是指能使受益人的生活质量得到净改善和/或提高预期寿命的措施。与发达国家不同，发展中国家对医疗保健最终产出的衡量标准所做的研究极少。本研究的目的是：(i) 运用现有的与健康相关的生活质量（HRQoL）方法，从生活和工作在肯尼亚血吸虫病流行区姆韦亚灌溉区的农民、教师和卫生专业人员那里获取健康状态估值；(ii) 确定血吸虫病感染风险较高的三类主要人群的平均健康状态估值之间是否存在显著差异；(iii) 评估不同受访者特征和健康状态预后对估值的相对影响。该工具包括七种健康状态描述——每种描述都沿着六个功能维度定义：自我护理、行动能力、生计活动能力、精力、社会参与和疼痛。使用视觉模拟量表（VAS）来测量主要健康状态值。从务农公众、医学专业人员和教师的三个随机样本中获取这些值。Kruskal-Wallis 单因素方差分析检验表明，从这三个样本中获得的平均健康状态值（针对轻度、中度、重度、极重度和昏迷状态）存在显著差异。一般来说，除了对紧接着后的状态的估值外，其他解释变量对于轻度、中度、重度和极重度状态的估值而言并非具有统计学意义的决定因素。结果表明，VAS 估值主要受预后影响。迫切需要开展更具代表性和系统性的 HRQoL 研究，以检验基于西方的通用工具在非洲国家背景下的相关性，以便在必要时开发更合适的工具。
