Improved malaria case management in formal private sector through public private partnership in Ethiopia: retrospective descriptive study.
Improved malaria case management in formal private sector through public private partnership in Ethiopia: retrospective descriptive study.
复制标题
DOI：
10.1186/s12936-016-1402-7
复制
发表时间：
2016-07-11
期刊：
影响因子：
3
通讯作者：
Abebe ME
中科院分区：
文献类型：
--
作者：
Argaw MD;Woldegiorgis AG;Abate DT;Abebe ME
疟疾是一个主要的公共卫生问题，据报告仍然是埃塞俄比亚发病和死亡的十大原因之一。超过三分之一的人向私营医疗部门寻求治疗。评估医疗保健提供者对标准的遵守情况对于确定服务提供的质量和有效性至关重要。因此，本研究的目的是评估公私混合（PPM）方法在提高正规私营医疗服务提供者疟疾病例管理质量方面的贡献。使用从位于阿姆哈拉、德雷达瓦、哈里里、奥罗米亚、南部民族和人民以及提格雷地区的疟疾护理设施的 110 PPM 收集的 2959 个设施月数据进行了回顾性数据分析。数据抽象格式用于按季度收集和整理数据。使用 Microsoft Office Excel 2010 手动清理和分析数据。为了声明统计显着性，进行了非参数 McNemar 检验，并以 P < 0.05 接受决策。 2012年4月至2015年9月，共发现873,707名疟疾疑似患者，其中四分之一（25.6%）作为疟疾病例接受治疗。在疟疾疑似病例中，疟疾调查比例较第一季度的 87.7% 提高至上季度的 100.0%（X2 = 66.84，P < 0.001）。大多数 (96.0%) 是通过显微镜或快速诊断测试得到寄生虫学确诊的病例。总体滑动阳性率为 25.1%，其中一半（50.7%）恶性疟原虫阳性，略低于一半（45.2%）间日疟原虫；其余 8790 例（4.1%）显示恶性疟原虫和间日疟原虫混合感染。使用蒿甲醚-本芴醇 (AL) 进行适当治疗的依从率从第一季度的 47.8% 提高到最后一个季度的 95.7%（X2 = 12.89，P < 0.001）。同样，使用氯喹 (CQ) 的正确患者管理率从第一季度的 44.1% 提高到上季度的 98.12%（X2 = 11.62，P < 0.001）。这项研究记录了医疗保健提供者遵守国家推荐的疟疾治疗标准的时间变化。疟疾护理服务 PPM 显着改善了正规私营卫生机构卫生保健提供者的疟疾病例管理实践。因此，地区卫生局和合作伙伴应密切合作，扩大已启动的疟疾护理服务 PPM。
Malaria is a major public health problem and still reported among the 10 top causes of morbidity and mortality in Ethiopia. More than one-third of the people sought treatment from the private health sector. Evaluating adherences of health care providers to standards are paramount importance to determine the quality and the effectiveness of service delivery. Therefore, the aim of this study was to evaluate the contribution of public private mix (PPM) approach in improving quality of malaria case management among formal private providers. A retrospective data analysis was conducted using 2959 facility-months data collected from 110 PPM for malaria care facilities located in Amhara, Dire Dawa, Hareri, Oromia, Southern Nation Nationalities and Peoples and Tigray regions. Data abstraction formats were used to collect and collate the data on quarterly bases. The data were manually cleaned and analysed using Microsoft Office Excel 2010. To claim statistical significance non-parametric McNemar test was done and decision accepted at P < 0.05. From April 2012–September 2015, a total of 873,707 malaria suspected patients were identified, of which one-fourth (25.6 %) were treated as malaria cases. Among malaria suspected cases the proportion of malaria investigation improved from recorded in first quarter 87.7–100.0 % in last quarter (X2 = 66.84, P < 0.001). The majority (96.0 %) were parasitologically-confirmed cases either by using microscopy or rapid diagnostic tests. The overall slid positivity rate was 25.1 % of which half (50.7 %) were positive for Plasmodium falciparum and slightly lower than half (45.2 %) for Plasmodium vivax; the remaining 8790 (4.1 %) showed mixed infections of P. falciparum and P. vivax. Adherence to appropriate treatment using artemether-lumefantrine (AL) was improved from 47.8 % in the first quarter to 95.7 % in the last quarter (X2 = 12.89, P < 0.001). Similarly, proper patient management using chloroquine (CQ) was improved from 44.1 % in the first quarter to 98.12 % in the last quarter (X2 = 11.62, P < 0.001). This study documented the chronological changes of adherence of health care providers with the national recommended standards to treat malaria. The PPM for malaria care services significantly improved the malaria case management practice of health care providers at the formal private health facilities. Therefore, regional health bureaus and partners shall closely work to scale up the initiated PPM for malaria care service.