Treating childhood pneumonia in hard-to-reach areas: a model-based comparison of mobile clinics and community-based care.
Treating childhood pneumonia in hard-to-reach areas: a model-based comparison of mobile clinics and community-based care.
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DOI：
10.1186/1472-6963-12-9
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发表时间：
2012-01-10
影响因子：
2.8
通讯作者：
Checchi F
中科院分区：
文献类型：
--
作者：
Pitt C;Roberts B;Checchi F
当难以接触的人群（例如生活在不安全地区的人群）无法获得基本卫生服务时，救援机构、捐助者和卫生部在选择最有效的干预策略时面临着两难境地。本文使用决策数学模型来评估两种替代策略（流动诊所和固定社区卫生服务）对儿童肺炎（世界上儿童死亡的主要原因）的抗生素治疗的相对有效性。使用 Excel 和 Visual Basic 开发了“马尔可夫循环树”队列模型，以比较三种情况下预期的 1 至 59 个月儿童肺炎死亡人数：1) 没有可用的治疗服务，2) 由高技能但间歇性的流动诊所提供的治疗服务，以及 3) 由低技能的社区卫生站提供的治疗服务。参数值是通过文献和专家访谈得出的。对几种可能的情况进行了概率敏感性分析。我们估计，未经治疗的每 10,000 个儿童日中，肺炎特异性 5 岁以下死亡率中位数为 0.51（95% 可信区间：0.49 至 0.541），每周流动诊所的死亡率为 0.45（95% CI：0.43 至 0.48），而社区卫生工作者在固定卫生站的死亡率为 0.31（95% CI：0.29 至 0.32）。敏感性分析发现，固定策略更优越，除非流动诊所每天访问社区，流动诊所的就医率明显高于固定诊所，或者几个变量同时与我们的基线假设有很大差异。目前的证据并不支持流动诊所比社区卫生工作者更有效的假设。因此，在高死亡率、难以进入的地区需要考虑社区卫生保健战略。不确定性仍然存在，参数值可能会因环境而异，但该模型允许在新的或特定于环境的证据可用时更新初步结果。决策分析模型可以指导难以进入的领域所需的实地研究工作，并为决策者提供基于证据的见解。
Where hard-to-access populations (such as those living in insecure areas) lack access to basic health services, relief agencies, donors, and ministries of health face a dilemma in selecting the most effective intervention strategy. This paper uses a decision mathematical model to estimate the relative effectiveness of two alternative strategies, mobile clinics and fixed community-based health services, for antibiotic treatment of childhood pneumonia, the world's leading cause of child mortality. A "Markov cycle tree" cohort model was developed in Excel with Visual Basic to compare the number of deaths from pneumonia in children aged 1 to 59 months expected under three scenarios: 1) No curative services available, 2) Curative services provided by a highly-skilled but intermittent mobile clinic, and 3) Curative services provided by a low-skilled community health post. Parameter values were informed by literature and expert interviews. Probabilistic sensitivity analyses were conducted for several plausible scenarios. We estimated median pneumonia-specific under-5 mortality rates of 0.51 (95% credible interval: 0.49 to 0.541) deaths per 10,000 child-days without treatment, 0.45 (95% CI: 0.43 to 0.48) with weekly mobile clinics, and 0.31 (95% CI: 0.29 to 0.32) with CHWs in fixed health posts. Sensitivity analyses found the fixed strategy superior, except when mobile clinics visited communities daily, where rates of care-seeking were substantially higher at mobile clinics than fixed posts, or where several variables simultaneously differed substantially from our baseline assumptions. Current evidence does not support the hypothesis that mobile clinics are more effective than CHWs. A CHW strategy therefore warrants consideration in high-mortality, hard-to-access areas. Uncertainty remains, and parameter values may vary across contexts, but the model allows preliminary findings to be updated as new or context-specific evidence becomes available. Decision analytic modelling can guide needed field-based research efforts in hard-to-access areas and offer evidence-based insights for decision-makers.
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影响因子：
168.9
作者：
Black, RE;Morris, SS;Bryce, J
通讯作者：
Bryce, J
影响因子：
2.4
作者：
Hutchings, Andrew;Raine, Rosalind;Black, Nick
通讯作者：
Black, Nick
影响因子：
3.6
作者：
Brisson, M.;Edmunds, W. J.
通讯作者：
Edmunds, W. J.
影响因子：
2
作者：
JOHNSON, AWBR;OSINUSI, K;ADEYEMIDORO, FAB
通讯作者：
ADEYEMIDORO, FAB
DOI：
10.2471/blt.08.053348
发表时间：
2008-05-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Greenwood, Brian
通讯作者：
Greenwood, Brian