Informal Health Provider and Practical Approach to Lung Health interventions to improve the detection of chronic airways disease and tuberculosis at primary care level in Malawi: study protocol for a randomised controlled trial.
Informal Health Provider and Practical Approach to Lung Health interventions to improve the detection of chronic airways disease and tuberculosis at primary care level in Malawi: study protocol for a randomised controlled trial.
复制标题
DOI：
10.1186/s13063-015-1068-4
复制
发表时间：
2015-12-17
期刊：
影响因子：
2.5
通讯作者：
Squire SB
中科院分区：
文献类型：
--
作者：
Banda HT;Mortimer K;Bello GA;Mbera GB;Namakhoma I;Thomson R;Nyirenda MJ;Faragher B;Madan J;Malmborg R;Stenberg B;Mpunga J;Mwagomba B;Gama E;Piddock K;Squire SB
在马拉维等发展中国家，在慢性咳嗽结核病检测呈阴性的患者之后，很少进行进一步的调查。慢性气道疾病的表现与肺结核有重叠。然而，由于缺乏诊断服务，慢性气道疾病常常未被识别。在发展中国家，初级卫生保健层面的转诊系统薄弱，患者转向不熟练的非正式卫生服务提供者寻求卫生保健。这些疾病的延迟诊断和治疗会加剧严重程度和结核病传播。世界卫生组织制定了肺部健康实用方法战略，该战略已被证明可以改善结核病和慢性气道疾病的管理。该指南解决了结核病和慢性气道疾病综合指南的需求。事实证明，与非正式卫生服务提供者合作可以有效提高卫生服务的利用率。然而，尚不清楚社区非正式卫生服务提供者的参与是否会对肺部健康实用方法战略的实施产生积极影响。我们将使用整群随机对照试验来确定使用两种干预措施改善结核病和慢性气道疾病患者的病例发现和治疗的效果。将使用三臂整群随机试验设计。初级卫生中心服务区的人口将形成一个集群，该集群将被随机分配到其中一个分支。第一批人员将接受肺部健康实用方法战略干预。除了这一战略之外，第二支部队人员还将接受非正式医疗服务提供者的培训。第三臂是控制臂。干预措施的效果将通过社区调查进行评估。有关慢性咳嗽的诊断和治疗的数据将从初级卫生中心收集。该试验旨在确定非正式医疗服务提供者和肺部健康实用干预措施对马拉维初级保健一级慢性气道疾病和结核病的检测和管理的效果。注册机构的唯一标识号是 PACTR201411000910192 – 2014 年 11 月 21 日 本文的在线版本 (doi:10.1186/s13063-015-1068-4) 包含补充材料，可供授权用户使用。
In developing countries like Malawi, further investigation is rare after patients with chronic cough test negative for tuberculosis. Chronic airways disease has presentations that overlap with tuberculosis. However, chronic airways disease is often unrecognised due to a lack of diagnostic services. Within developing countries, referral systems at primary health care level are weak and patients turn to unskilled informal health providers to seek health care. Delayed diagnosis and treatment of these diseases facilitates increased severity and tuberculosis transmission. The World Health Organisation developed the Practical Approach to Lung Health strategy which has been shown to improve the management of both tuberculosis and chronic airways disease. The guidelines address the need for integrated guidelines for tuberculosis and chronic airways disease. Engaging with informal health providers has been shown to be effective in improving health services uptake. However, it is not known whether engaging community informal health providers would have a positive impact in the implementation of the Practical Approach to Lung Health strategy. We will use a cluster randomised controlled trial to determine the effect of using the two interventions to improve case detection and treatment of patients with tuberculosis and chronic airways disease. A three-arm cluster randomised trial design will be used. A primary health centre catchment population will form a cluster, which will be randomly allocated to one of the arms. The first arm personnel will receive the Practical Approach to Lung Health strategy intervention. In addition to this strategy, the second arm personnel will receive training of informal health providers. The third arm is the control. The effect of interventions will be evaluated by community surveys. Data regarding the diagnosis and management of chronic cough will be gathered from primary health centres. This trial seeks to determine the effect of Informal Health Provider and Practical Approach to Lung Health interventions on the detection and management of chronic airways disease and tuberculosis at primary care level in Malawi. The unique identification number for the registry is PACTR201411000910192 – 21 November 2014 The online version of this article (doi:10.1186/s13063-015-1068-4) contains supplementary material, which is available to authorized users.