Developing a Buruli ulcer community of practice in Bankim, Cameroon: A model for Buruli ulcer outreach in Africa
Developing a Buruli ulcer community of practice in Bankim, Cameroon: A model for Buruli ulcer outreach in Africa
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DOI：
10.1371/journal.pntd.0006238
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发表时间：
2018-03-01
影响因子：
3.8
通讯作者：
Nichter, Mark
中科院分区：
文献类型：
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作者：
Awah, Paschal Kum;Boock, Alphonse Um;Nichter, Mark
背景在喀麦隆，以前通过动员社区卫生工作者（CHW）来识别布鲁里溃疡（BU）的努力效果不佳。在本文中，我们描述了一个BU社区的实践（BUCOP）在班金，喀麦隆组成的医院工作人员，以前的病人，CHWs，和传统healers.Methods和原则findingsAll七个阶段的一个明确的形成性研究过程中进行了三个阶段的研究进行了密切合作的社会科学家团队与班金医院的工作人员。第一阶段人种学研究产生的干预措施在第二阶段概念验证研究中进行了测试，随后是一个为期三年的试点项目。在第三阶段，对试点项目进行了评估。一项结果评价记录了布鲁里溃疡检出率的显著上升，特别是I类病例，以及病例转诊的转变。经过培训的社区卫生工作者和传统治疗师最初将大多数布鲁里溃疡疑似病例转诊到班金医院。随着时间的推移，家庭成员接触到创新和文化敏感的推广教育计划，提出了最多的疑似病例。社区利益相关者转介的疑似布鲁里溃疡病例的实验室确认率在30%以上。一项影响和过程评价发现，保健工作人员、社区卫生工作者和传统治疗师之间实现了持续合作。社区工作者开始在组织BU外展活动中发挥更积极的作用，这提高了他们的社会地位。传统的治疗师发现，他们获得更多的合作比他们失去了referreration.Conclusion/Significance建立沟通渠道，并促进社区利益相关者和卫生工作人员之间的合作和信任是必不可少的被忽视的热带疾病的控制。这对于加强卫生系统和防范新出现的疾病也至关重要。本文所述的BUCOP模式具有很大的希望，使社区一起解决紧迫的健康问题，在文化上敏感的方式。
BackgroundIn the Cameroon, previous efforts to identify Buruli ulcer (BU) through the mobilization of community health workers (CHWs) yielded poor results. In this paper, we describe the successful creation of a BU community of practice (BUCOP) in Bankim, Cameroon composed of hospital staff, former patients, CHWs, and traditional healers.Methods and principle findingsAll seven stages of a well-defined formative research process were conducted during three phases of research carried out by a team of social scientists working closely with Bankim hospital staff. Phase one ethnographic research generated interventions tested in a phase two proof of concept study followed by a three-year pilot project. In phase three the pilot project was evaluated. An outcome evaluation documented a significant rise in BU detection, especially category I cases, and a shift in case referral. Trained CHW and traditional healers initially referred most suspected cases of BU to Bankim hospital. Over time, household members exposed to an innovative and culturally sensitive outreach education program referred the greatest number of suspected cases. Laboratory confirmation of suspected BU cases referred by community stakeholders was above 30%. An impact and process evaluation found that sustained collaboration between health staff, CHWs, and traditional healers had been achieved. CHWs came to play a more active role in organizing BU outreach activities, which increased their social status. Traditional healers found they gained more from collaboration than they lost from referral.Conclusion/SignificanceSetting up lines of communication, and promoting collaboration and trust between community stakeholders and health staff is essential to the control of neglected tropical diseases. It is also essential to health system strengthening and emerging disease preparedness. The BUCOP model described in this paper holds great promise for bringing communities together to solve pressing health problems in a culturally sensitive manner.