Routes to Government TB Treatment: Private Providers, Family Support, and the Process of TB Treatment Seeking among Ugandan Women
Routes to Government TB Treatment: Private Providers, Family Support, and the Process of TB Treatment Seeking among Ugandan Women
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DOI：
10.1111/j.1548-1387.2009.01059.x
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发表时间：
2009-01-01
影响因子：
2.2
通讯作者：
Chard, Sarah E.
中科院分区：
文献类型：
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作者：
Chard, Sarah E.
结核病仍然是乌干达发病率和死亡率的主要来源。本横断面研究探讨了乌干达妇女结核病寻求治疗的过程，以确定有效的政府结核病治疗的城市，半农村和农村妇女的样本之间的路线。这项研究特别侧重于妇女，因为患有结核病的乌干达妇女必须在妇女往往在政治和经济上被边缘化的背景下谈判其治疗途径，对家庭资源和年长家庭成员的保健决定的控制有限。结果检查结构，社会和经济力量同样指导治疗寻求在三个研究地点，然后设置之间的具体差异。研究结果表明，非政府医疗保健提供者的诊断和转诊数量有限，特别是对于城市和半农村参与者，是生物医学结核治疗的一个关键障碍。私营提供者的诊断延误也会带来财务和物质成本，这会损害可用于随后结核病治疗的资源以及参与者的社会和经济福祉。这项研究表明，寻求治疗的政治经济学的概念化需要更充分地认识到寻求治疗的微观政治经济背景的动态性质，包括多米诺骨牌的社会，经济和健康影响的结构性问题的医疗保健系统。
Tuberculosis (TB) remains a major source of morbidity and mortality in Uganda. This cross-sectional study explores Ugandan women's TB treatment-seeking processes to determine the routes to effective government TB treatment among a sample of urban, semirural, and rural women. This research focuses on women in particular as Ugandan women with tuberculosis must negotiate their treatment paths in a context where women tend to be politically and economically marginalized, with limited control of household resources and senior family members' health care decisions. The results examine the structural, social, and economic forces similarly guiding treatment seeking across the three research sites and then the specific differences among the settings. The findings suggest that the modest number of nongovernmental health care providers' diagnoses and referrals, particularly for urban and semirural participants, represents a critical barrier to biomedical TB treatment. Private providers' diagnosis delays also carry financial and physical costs, which undermine the resources available for subsequent TB treatment and participants' social and economic well-being. This study indicates that conceptualizations of the political economy of treatment seeking need to more fully acknowledge the dynamic nature of the microlevel political economic context of treatment seeking, including the domino social, economic, and health effects of structurally problematic health care systems.