Socio-cultural factors explaining timely and appropriate use of health facilities for degedege in south-eastern Tanzania
Socio-cultural factors explaining timely and appropriate use of health facilities for degedege in south-eastern Tanzania
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DOI：
10.1186/1475-2875-8-144
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发表时间：
2009-06-29
期刊：
影响因子：
3
通讯作者：
Obrist, Brigit
中科院分区：
文献类型：
--
作者：
Dillip, Angel;Hetzel, Manuel W.;Obrist, Brigit
背景：抽搐是五岁以下儿童严重疟疾的主要症状之一，可能导致严重并发症或死亡。几项关于求医行为的研究表明，与抽搐（坦桑尼亚斯瓦希里语称为degedege）有关的当地疾病概念要求采用传统治疗方法，而现代治疗更适合用于普通发烧。然而，最近的研究发现，即使是抽搐的儿童也首先被带到卫生机构。这项研究综合了人种学和公共卫生方法，以调查这一看似矛盾的证据。仔细抽取的随机样本被用来最大限度地提高结果的代表性。方法：本研究采用了文化流行病学方法，并采用了当地改编的解释性模型访谈目录（EMIC），以确保对疾病认知和治疗模式进行全面调查。该工具应用于三项研究；i) 2004年随机抽样横断面社区发热调查（N = 80）， ii) 2004-2006年纵向分层研究（N = 129）， iii) 2005年主要农作季节发热队列研究（N = 29）。结果：71.1%的惊厥病例被及时送往卫生机构，即在出现首次症状后24小时内。这与儿童轻度发热病例的45.6%的数字相比非常有利。在患疟疾的儿童中，与不及时使用保健设施和接受抗疟疾药物有关的痛苦模式是全身性症状，而不是抽搐的典型症状。传统和道德原因与不及时使用卫生设施和接受抗疟疾药物有关。然而，适当行动的高比率表明，这些想法不再像过去那样有影响力。对不去医疗机构的儿童提供抗疟疾药物的看护人给出的理由是，要么医疗机构缺货，要么他们没有钱支付治疗费，要么医疗机构不提供诊断。结论：来自疟疾高度流行地区的这一样本的调查结果支持了最近的研究，这些研究表明，与传统做法相比，惊厥儿童更有可能使用卫生设施。这项研究确定了卫生系统和生计因素，而不是当地对与degedege相关的症状和原因的理解，这些因素限制了求医行为。为了确保人们得到及时和适当的治疗，有必要改进供应方和需求方：需要提高卫生设施的护理质量，使诊断和提供者更准确地遵守治疗准则，使社区更容易获得和负担得起包括药物在内的治疗方法。需要通过加强生计包括经济能力来促进寻求治疗。
Background: Convulsions is one of the key signs of severe malaria among children under five years of age, potentially leading to serious complications or death. Several studies of care-seeking behaviour have revealed that local illness concepts linked to convulsions (referred to as degedege in Tanzanian Kiswahili) called for traditional treatment practices while modern treatment was preferred for common fevers. However, recent studies found that even children with convulsions were first brought to health facilities. This study integrated ethnographic and public health approaches in order to investigate this seemingly contradictory evidence. Carefully drawn random samples were used to maximize the representativity of the results.Methods: The study used a cultural epidemiology approach and applied a locally adapted version of the Explanatory Model Interview Catalogue (EMIC), which ensures a comprehensive investigation of disease perception and treatment patterns. The tool was applied in three studies; i) the 2004 random sample cross-sectional community fever survey (N = 80), ii) the 2004-2006 longitudinal degedege study (N = 129), and iii) the 2005 cohort study on fever during the main farming season (N = 29).Results: 71.1% of all convulsion cases were brought to a health facility in time, i. e. within 24 hours after onset of first symptoms. This compares very favourably with a figure of 45.6% for mild fever cases in children. The patterns of distress associated with less timely health facility use and receipt of anti-malarials among children with degedege were generalized symptoms, rather than the typical symptoms of convulsions. Traditional and moral causes were associated with less timely health facility use and receipt of anti-malarials. However, the high rate of appropriate action indicates that these ideas were not so influential any more as in the past. Reasons given by caretakers who administered anti-malarials to children without attending a health facility were either that facilities were out of stock, that they lacked money to pay for treatment, or that facilities did not provide diagnosis.Conclusion: The findings from this sample from a highly malaria-endemic area give support to the more recent studies showing that children with convulsions are more likely to use health facilities than traditional practices. This study has identified health system and livelihood factors, rather than local understandings of symptoms and causes relating to degedege as limiting health-seeking behaviours. Improvements on the supply side and the demand side are necessary to ensure people's timely and appropriate treatment: Quality of care at health facilities needs to be improved by making diagnosis and provider compliance with treatment guidelines more accurate and therapies including drugs more available and affordable to communities. Treatment seeking needs to be facilitated by strengthening livelihoods including economic capabilities.