Malaria control at the district level in Africa: The case of the Muheza district in northeastern Tanzania
Malaria control at the district level in Africa: The case of the Muheza district in northeastern Tanzania
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DOI：
10.4269/ajtmh.2004.71.205
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发表时间：
2004-08-01
影响因子：
3.3
通讯作者：
Bygbjerg, IC
中科院分区：
文献类型：
--
作者：
Alilio, MS;Kitua, A;Bygbjerg, IC
在坦桑尼亚进行了一项评估，以确定自1980年代建立初级保健制度以来，初级保健服务在多大程度上有助于减轻疟疾负担。使用了七个描述性过程和成效成果指标：疟疾传播和发病率随时间的变化;使用基于设施的疟疾护理服务;病人获得专业咨询的机会;磺胺乙胺嘧啶和氯喹治疗失败的趋势;严重病例在地区医院的存活率;地区疟疾控制战略;为护理人员提供的疟疾专门培训的次数;以及采取灭蚊措施的次数。这些数据是1996年至2003年在坦桑尼亚东北部的Muheza区收集的。它包括对1 250名答卷人进行分层抽样的家庭访谈，以及对该地区35个保健设施的所有175名保健提供者进行深入访谈。区卫生管理小组的所有六名成员也接受了采访。其他数据来自药房和医院记录以及已发表的文献。结果表明，疟疾疾病负担没有变化。自1960年代以来，该地区每名5岁以下儿童的平均疟疾临床发作次数一直保持在每年3至3.5次之间。将5岁以下人口的预期病例与地区卫生机构的病例进行比较，结果显示覆盖率为33%。此外，在1990年至2003年期间，几乎没有向保健工作人员提供关于疟疾的培训。调查结果表明，地区卫生服务对疟疾控制的有效性有限，表明国家疟疾目标转化为地区一级活动的过程薄弱。
An assessment was done in Tanzania to determine the extent to which the primary health care services have contributed to reducing the burden of malaria since the system was initiated in the 1980s. Seven descriptive processes and outcome indicators of effectiveness were used: changes of malaria transmission and incidence over time; use of facility-based care services for malaria; patients' access to professional advice; the trend of treatment failure over time of sulfadoxine-pyrimethamine and chloroquine; survival rates of severe cases at the district hospital; a district malaria control strategy; number of malaria specific training for care providers; and the number of activities carried out on mosquito control measures. The data were collected from 1996 to 2003 in the Muheza district northeastern Tanzania. It covered household interviews with a stratified sample of 1,250 respondents, and in-depth interviews with all 175 health care providers in the 35 health facilities within the district. All six members of the district health management team were also interviewed. Additional data came from dispensary and hospital records, and published literature. The results show an unchanged malaria disease burden. The average number of clinical malaria episodes per child less than five years of age remained between 3 and 3.5 episodes per year in the district since the 1960s. The comparison of cases expected in the population less than five years old with those seen in the district health facilities shows a coverage rate of 33%. Furthermore, between 1990 and 2003, little training on malaria was provided to health staff. The findings imply a limited effectiveness of district health services on malaria control, suggesting a weak process of translating national malaria goals to activities at the district level.