Improved clinical and laboratory skills after team-based, malaria case management training of health care professionals in Uganda
Improved clinical and laboratory skills after team-based, malaria case management training of health care professionals in Uganda
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DOI：
10.1186/1475-2875-11-44
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发表时间：
2012-02-13
期刊：
影响因子：
3
通讯作者：
Yeka, Adoke
中科院分区：
文献类型：
--
作者：
Namagembe, Allen;Ssekabira, Umaru;Yeka, Adoke
背景资料：为治疗无并发症的疟疾而采用高效青蒿素类复方疗法，需要更好地确定疟疾治疗的目标，以改善病例管理，并尽量减少选择抗药性寄生虫的药物压力。疟疾课程的综合管理开发培训多学科团队的临床，实验室和卫生信息assistants.Methods：在9个卫生设施，乌干达疟疾监测方案（UMSP）的网站进行了培训评价。2006年12月至2007年6月，194名保健专业人员参加了为期六天的课程。118名临床医生中有101名（86%）在基线时和课程结束后约6周、12周和1年的3次随访访视期间由专家临床医生观察患者。专家们对5岁以下的儿童使用了标准化的工具，对5岁或5岁以上的患者使用了类似的工具。对30名实验室专业人员中的17名（57%）进行了疟疾血涂片制备和30张质控玻片涂片结果判读能力的评估。基线和首次随访时，正确采集病史的患者百分比分别为21%和43%，全面体格检查的患者百分比分别为18%和56%，正确诊断的患者百分比分别为51%和98%，治疗符合国家政策42%和86%，适当的患者教育17%和83%。在调整个体效应和匹配样本的估计中，相对风险为1.86（95%CI：1.20，2.88）病史采集，2.66（95%CI：1.60，4.41）体格检查，1.77诊断组、治疗组和患者教育组的预测值分别为1.41，2.23（95%CI：1.46，2.63）、1.96（95%CI：2.68，7.46）。后续随访和按患者年龄分层的子样本的结果相似。疟疾血涂片制备的质量从基线的21.6%提高到首次随访的67.3%（p < 0.008）;质量控制切片的解释敏感性从48.6%提高到70.6%（p < 0.199），特异性从72.1%提高到77.2%（p < 0.736）。结果是相似的后续行动，除了一个显着增加的特异性（94.2%，p < 0.036）在一年。结论：多学科的团队培训导致临床和实验室技能的统计学显着改善。作为一个联合方案，其影响不能与UMSP活动区分开来，但可以支持长期、持续的能力建设和监测干预措施。
Background: Deployment of highly effective artemisinin-based combination therapy for treating uncomplicated malaria calls for better targeting of malaria treatment to improve case management and minimize drug pressure for selecting resistant parasites. The Integrated Management of Malaria curriculum was developed to train multi-disciplinary teams of clinical, laboratory and health information assistants.Methods: Evaluation of training was conducted in nine health facilities that were Uganda Malaria Surveillance Programme (UMSP) sites. From December 2006 to June 2007, 194 health professionals attended a six-day course. One-hundred and one of 118 (86%) clinicians were observed during patient encounters by expert clinicians at baseline and during three follow-up visits approximately six weeks, 12 weeks and one year after the course. Experts used a standardized tool for children less than five years of age and similar tool for patients five or more years of age. Seventeen of 30 laboratory professionals (57%) were assessed for preparation of malaria blood smears and ability to interpret smear results of 30 quality control slides.Results: Percentage of patients at baseline and first follow-up, respectively, with proper history-taking was 21% and 43%, thorough physical examination 18% and 56%, correct diagnosis 51% and 98%, treatment in compliance with national policy 42% and 86%, and appropriate patient education 17% and 83%. In estimates that adjusted for individual effects and a matched sample, relative risks were 1.86 (95% CI: 1.20,2.88) for history-taking, 2.66 (95% CI: 1.60,4.41) for physical examination, 1.77 (95% CI: 1.41,2.23) for diagnosis, 1.96 (95% CI: 1.46,2.63) for treatment, and 4.47 (95% CI: 2.68,7.46) for patient education. Results were similar for subsequent follow-up and in sub-samples stratified by patient age. Quality of malaria blood smear preparation improved from 21.6% at baseline to 67.3% at first follow-up (p < 0.008); sensitivity of interpretation of quality control slides increased from 48.6% to 70.6% (p < 0.199) and specificity increased from 72.1% to 77.2% (p < 0.736). Results were similar for subsequent follow-up, with the exception of a significant increase in specificity (94.2%, p < 0.036) at one year.Conclusion: A multi-disciplinary team training resulted in statistically significant improvements in clinical and laboratory skills. As a joint programme, the effects cannot be distinguished from UMSP activities, but lend support to long-term, on-going capacity-building and surveillance interventions.