Treatment actions and treatment failure: case studies in the response to severe childhood febrile illness in Mali
Treatment actions and treatment failure: case studies in the response to severe childhood febrile illness in Mali
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DOI：
10.1186/1471-2458-12-946
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发表时间：
2012-11-05
影响因子：
4.5
通讯作者：
Winch, Peter J.
中科院分区：
文献类型：
--
作者：
Ellis, Amy A.;Traore, Sidy;Winch, Peter J.
背景：适当的家庭疾病管理对于控制疟疾至关重要。家庭管理策略依赖于护理人员识别疟疾症状、评估严重程度并在必要时及时到医疗机构寻求适当的护理。本文探讨了马里库利科罗地区农村地区 5 岁以下儿童严重发热性疾病（推测为疟疾）的管理情况。 方法：本研究对 25 个最近患有严重发热性疾病家庭的 25 个家庭进行了深入的案例研究，并对主要知情者进行了访谈，并与社区成员进行了焦点小组讨论。这些技术用于探索严重疾病发作期间采取的治疗步骤的顺序以及做出与寻求治疗和护理来源有关的决策的背景，同时纳入母亲以及大家庭的观点和意见。 结果：在 25 个符合纳入标准的家庭中招募了 81 名参与者。儿童疾病发作涉及多个治疗步骤，平均每次发作4.4个治疗步骤（范围：2-10）。 76% 的儿童在家里开始接受治疗，但 80% 的儿童在户外接受治疗作为第二选择。大多数家庭同时使用传统和现代治疗方法，由家庭成员在家中或由传统或现代治疗师进行治疗。尽管报告的治疗失败率很高（52%，n=12），但参与者表示更喜欢现代护理，但传统治疗也常常被认为是适当和有效的。在医疗机构寻求医疗服务时最常提到的障碍是费用，尤其是在雨季。经济拮据往往导致家庭使用传统疗法。结论：在健康和经济危机重叠的时刻，家庭几乎没有什么选择。公共卫生研究和政策应侧重于减少阻碍贫困家庭及时寻求适当医疗保健的障碍。提高社区卫生机构提供的护理质量以及快速识别和解决治疗失败的支持机制，有助于减少后续治疗延误并避免不恰当地诉诸传统治疗。
Background: Appropriate home management of illness is vital to efforts to control malaria. The strategy of home management relies on caregivers to recognize malaria symptoms, assess severity and promptly seek appropriate care at a health facility if necessary. This paper examines the management of severe febrile illness (presumed malaria) among children under the age of five in rural Koulikoro Region, Mali.Methods: This research examines in-depth case studies of twenty-five households in which a child recently experienced a severe febrile illness, as well as key informant interviews and focus group discussions with community members. These techniques were used to explore the sequence of treatment steps taken during a severe illness episode and the context in which decisions were made pertaining to pursing treatments and sources of care, while incorporating the perspective and input of the mother as well as the larger household.Results: Eighty-one participants were recruited in 25 households meeting inclusion criteria. Children's illness episodes involved multiple treatment steps, with an average of 4.4 treatment steps per episode (range: 2-10). For 76% of children, treatment began in the home, but 80% were treated outside the home as a second recourse. Most families used both traditional and modern treatments, administered either inside the home by family members, or by traditional or modern healers. Participants' stated preference was for modern care, despite high rates of reported treatment failure (52%, n=12), however, traditional treatments were also often deemed appropriate and effective. The most commonly cited barrier to seeking care at health facilities was cost, especially during the rainy season. Financial constraints often led families to use traditional treatments.Conclusions: Households have few options available to them in moments of overlapping health and economic crises. Public health research and policy should focus on the reducing barriers that inhibit poor households from promptly seeking appropriate health care. Enhancing the quality of care provided at community health facilities and supporting mechanisms by which treatment failures are quickly identified and addressed can contribute to reducing subsequent treatment delays and avoid inappropriate recourse to traditional treatments.