Community perspectives on treating asymptomatic infections for malaria elimination in The Gambia
Community perspectives on treating asymptomatic infections for malaria elimination in The Gambia
复制标题
DOI：
10.1186/s12936-019-2672-7
复制
发表时间：
2019-02-18
期刊：
影响因子：
3
通讯作者：
Grietens, Koen Peeters
中科院分区：
文献类型：
--
作者：
Jaiteh, Fatou;Masunaga, Yoriko;Grietens, Koen Peeters
背景：消除无症状疟疾感染的创新和具有成本效益的战略是实现消除疟疾目标所必需的，但这仍然是一个挑战。这项混合方法研究探讨了人们对用3天疗程的双氢青蒿素-哌喹（DHAP）治疗疟疾病例复合接触者的反应性治疗的态度，无症状感染的社会文化表征，更具体地说，他们的治疗。方法：在干预开始前，进行顺序混合方法研究。定性数据收集包括与来自试验社区和试验工作人员的关键举报人进行深入访谈和参与者观察（包括非正式谈话）。定量数据来源于对随机选择的研究社区成员的健康素养和求医行为的试验前横断面调查。结果：在试验前横断面调查中，73%的应答者报告说，疟疾可能隐藏在体内，没有症状。虽然这可以解释为人们对无症状疟疾的理解，但定性数据表明，举报人对无症状疾病的解释与生物医学模型不同。它被描述为：(i)一种不妨碍人们进行日常活动的小病；（ii）在有症状和无症状阶段之间摇摆的疾病；以及（iii）疾病因子存在于体内但仍然隐藏的状态，没有迹象和症状，直到某些事情触发它们的表现。此外，据报告，这种形式的隐性疟疾在与疟疾病例生活在同一院落的人群中最为常见（71%）。结论：药物治疗无症状疟疾是可以接受的。然而，人们不确定是否要在不首先进行疟疾筛查的情况下接受治疗，这主要是由于缺乏症状。对无症状疟疾的了解并不能有力地加强治疗依从性。在本研究中，干预前社区的积极参与存在，让人们共同设计关于他们个人疟疾风险的准确信息信息，这增加了他们对专家知识的信任，从而被证明是成功实施社区干预的关键。
Background: Innovative and cost-effective strategies that clear asymptomatic malaria infections are required to reach malaria elimination goals, but remain a challenge. This mixed methods study explored people's attitudes towards the reactive treatment of compound contacts of malaria cases with a 3-day course of dihydroartemisinin-piperaquine (DHAP), the socio-cultural representations of asymptomatic infections, and more specifically their treatment.Methods: Prior to the start of the intervention, a sequential mixed method study was carried out. Qualitative data collection involved in-depth interviews and participant observations (including informal conversations) with key informants from the trial communities and the trial staff. Quantitative data were derived from a pre-trial cross-sectional survey on health literacy and health-seeking behaviour among randomly selected members of the study communities.Results: In the pre-trial cross-sectional survey, 73% of respondents reported that malaria could be hidden in the body without symptoms. Whilst this may be interpreted as people's comprehension of asymptomatic malaria, qualitative data indicated that informants had different interpretations of asymptomatic disease than the biomedical model. It was described as: (i) a minor illness that does not prevent people carrying out daily activities; (ii) an illness that oscillates between symptomatic and asymptomatic phases; and, (iii) a condition where disease agents are present in the body but remain hidden, without signs and symptoms, until something triggers their manifestation. Furthermore, this form of hidden malaria was reported to be most present in those living in the same compound with a malaria case (71%).Conclusion: Treating asymptomatic malaria with pharmaceuticals was considered acceptable. However, people felt uncertain to take treatment without screening for malaria first, largely due to the lack of symptoms. Knowledge of asymptomatic malaria was not a strong re-inforcement for treatment adherence. In this study, the pre-intervention active engagement of communities existed of having people co-design accurate information messages about their personal risk of malaria, which increased their trust in expert knowledge and thus proved essential for the successful implementation of the community-based intervention.