Changing home treatment of childhood fevers by training shop keepers in rural Kenya
Changing home treatment of childhood fevers by training shop keepers in rural Kenya
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DOI：
10.1046/j.1365-3156.1999.00403.x
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发表时间：
1999-05-01
影响因子：
3.3
通讯作者：
Marsh, K
中科院分区：
文献类型：
--
作者：
Marsh, VM;Mutemi, WM;Marsh, K
背景技术非洲的疟疾控制主要依赖于临床疾病的早期有效治疗，但大多数发烧的早期治疗是通过使用商店购买的药物进行自我治疗。社区成员缺乏有关非处方药使用的信息，导致发烧治疗普遍无效、药物毒性风险增加并加速耐药性。我们研究了可行性，并衡量了在非洲农村地区培训店主对社区吸毒的可能影响。方法在肯尼亚沿海的一个农村地区，我们根据社区内的形成性研究，在为大约 3500 人提供服务的 23 家商店实施了店主培训计划。我们通过测量购买足量氯喹的药品销售比例的变化以及给予足量氯喹的家庭治疗儿童发烧的百分比来评估培训。店主培训后，该计划在社区进行了定性评估。 结果 发烧儿童药品销售百分比（包括抗疟药）从培训前的 34.3%（95% CI 28.9%-40.1%）上升到培训后的最低 79.3%（95% CI 71.8%-85.3%）。购买足量药物的抗疟药物销售比例从 31.8% (95% CI 26.6%-37.6%) 上升到最低的 82.9% (95% CI 76.3%-87.3%)。给予儿童足够剂量氯喹的儿童发烧百分比从训练前的 3.7% (95% CI 1.2%-9.7%) 上升到训练后的最低 65.2% (95% CI 57.7%-72.0%)，这意味着非处方氯喹的适当使用增加了至少 62% (95% CI 53.7%-69.3%）。店主和社区成员强烈支持该计划的目标和结果。 结论 观察到的行为的巨大转变表明，培训店主作为向社区提供信息的渠道的方法不仅可行，而且可能产生重大影响。虽然所看到的一些影响可能归因于规模相对较小的试点研究的研究效果，但变化的幅度支持进一步研究这种方法，将其作为疟疾控制的潜在重要新策略。
BACKGROUND Malaria control in Africa relies primarily on early effective treatment for clinical disease, but most early treatments for fever occur through self-medication with shop-bought drugs. Lack of information to community members on over-the-counter drug use has led to widespread ineffective treatment of fevers, increased risks of drug toxicity and accelerating drug resistance. We examined the feasibility and measured the likely impact of training shop keepers in rural Africa on community drug use.METHODS In a rural area of coastal Kenya, we implemented a shop keeper training programme in 23 shops serving a population of approximately 3500, based on formative research within the community We evaluated the training by measuring changes in the proportions of drug sales where an adequate amount of chloroquine was purchased and in the percentage of home-treated childhood fevers given an adequate amount of chloroquine. The programme was assessed qualitatively in the community following the shop keeper training.RESULTS The percentage of drug sales for children with fever which included an antimalarial drug rose from 34.3% (95% CI 28.9%-40.1%) before the training to a minimum of 79.3% (95% CI 71.8%-85.3%) after the training. The percentage of antimalarial drug sales where an adequate amount of drug was purchased rose from 31.8% (95% CI 26.6%-37.6%) to a minimum of 82.9% (95% CI 76.3%-87.3%). The percentage of childhood fevers where an adequate dose of chloroquine was given to the child rose from 3.7% (95% CI 1.2%-9.7%) before the training to a minimum of 65.2% (95% CI 57.7%-72.0%) afterwards, which rep resents an increase in the appropriate use of over-the-counter chloroquine by at least 62% (95% CI 53.7%-69.3%). Shop keepers and community members were strongly supportive of the aims and outcome of the programme.CONCLUSIONS The large shifts in behaviour observed indicate that the approach of training shop keepers as a channel for information to the community is both feasible and likely to have a significant impact. Whilst some of the impact seen may be attributable to research effects in a relatively small scale pilot study, the magnitude of the changes support further investigation into this approach as a potentially important new strategy in malaria control.