Health care-seeking behaviour and diagnostic delays for Human African Trypanosomiasis in the Democratic Republic of the Congo
Health care-seeking behaviour and diagnostic delays for Human African Trypanosomiasis in the Democratic Republic of the Congo
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DOI：
10.1111/j.1365-3156.2011.02772.x
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发表时间：
2011-07-01
影响因子：
3.3
通讯作者：
Boelaert, M.
中科院分区：
文献类型：
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作者：
Hasker, E.;Lumbala, C.;Boelaert, M.
目的在刚果民主共和国（DRC）报告的非洲人锥虫病（HAT）患者中，约有一半是由固定的卫生机构而不是由移动的团队发现的。鉴于最近的政策，将HAT控制到一般的卫生服务，我们研究了这些自发呈现patients.METHODS的健康寻求行为，我们采取了一个随机样本，从所有患者诊断为第一次HAT发作通过被动的情况下发现2008年10月1日至2009年9月30日在刚果民主共和国的两个最流行的省份。患者在家中进行了结构化访谈。我们记录了患者延迟（即症状发作和联系卫生中心之间的时间）和卫生系统延迟（即首次接触和正确诊断HAT之间的时间）。结果患者延迟中位数为4个月（IQR 1-10个月，n = 66）;卫生系统延迟中位数为3个月（IQR 0.5-11个月）。首次到公共卫生中心就诊的患者的中位系统延迟时间为7个月（IQR 2-14个月，n = 23）。中位数，患者诊断后，第四次访问的卫生设施（IQR第3 - 7次访问）。结论大量的病人以及卫生系统的延误发生在被动检测的HAT病例。公共卫生中心在HAT的诊断工作中表现不佳，主要是因为HAT是一种相对罕见的疾病，早期症状很少且无特异性。将HAT诊断和治疗纳入一般保健服务需要强有力的技术支持和组织良好的监督和转诊机制。
OBJECTIVE About half of the patients with Human African trypanosomiasis (HAT) reported in the Democratic Republic of the Congo (DRC) are currently detected by fixed health facilities and not by mobile teams. Given the recent policy to integrate HAT control into general health services, we studied health seeking behaviour in these spontaneously presenting patients.METHODS We took a random sample from all patients diagnosed with a first-time HAT episode through passive case finding between 1 October 2008 and 30 September 2009 in the two most endemic provinces of the DRC. Patients were approached at their homes for a structured interview. We documented patient delay (i.e. time between onset of symptoms and contacting a health centre) and health system delay (i.e. time between first contact and correct diagnosis of HAT).RESULTS Median patient delay was 4 months (IQR 1-10 months, n = 66); median health system delay was 3 months (IQR 0.5-11 months). Those first presenting to public health centres had a median systems delay of 7 months (IQR 2-14 months, n = 23). On median, patients were diagnosed upon the forth visit to a health facility (IQR 3rd-7th visit).CONCLUSIONS Substantial patient as well as health system delays are incurred in HAT cases detected passively. Public health centres are performing poorly in the diagnostic work-up for HAT, mainly because HAT is a relatively rare disease with few and non-specific early symptoms. Integration of HAT diagnosis and treatment into general health services requires strong technical support and well-organized supervision and referral mechanisms.