Understanding Interpretations of and Responses to Childhood Fever in the Chikhwawa District of Malawi
Understanding Interpretations of and Responses to Childhood Fever in the Chikhwawa District of Malawi
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DOI：
10.1371/journal.pone.0125439
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发表时间：
2015-06-18
期刊：
影响因子：
3.7
通讯作者：
Lalloo, David G.
中科院分区：
文献类型：
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作者：
Ewing, Victoria L.;Tolhurst, Rachel;Lalloo, David G.
普遍获得和社区接受疟疾预防和治疗战略对于实现当前减少疟疾的目标至关重要。必须考虑寻求治疗途径中的每一步，以便确定哪里有成功参与和治疗的机会。我们描述了当地的儿童发热性疾病的分类，提出了一个寻求治疗的概述，从认识到疾病，并建议如何干预措施可以用来针对的障碍experienced.MethodsQualitative数据之间收集2010年9月和2011年2月。共有12个焦点小组讨论和22个关键事件访谈进行了与主要照顾者谁报告了最近的发热事件为他们的childh.Findings和ConclusionThe短语“kutentha thupi”，或“热体”被用来描述发烧，最常提到的原因是malungo（翻译为“疟疾”），mauka，nyankhwa和（M）tsempho。区分病因是具有挑战性的，因为这些疾病被描述为具有许多相似的非特异性症状，尽管在疾病的感知机制方面存在相当大的差异。Malungo被广泛认为是由蚊子引起的。常见的症状包括：发烧、虚弱、呕吐、腹泻和咳嗽。这些症状完全符合疟疾的生物医学定义，尽管在生物医学模式和当地疾病分类中，它们也与其他疾病的症状重叠。此外，malungo可互换使用来描述疟疾和发烧。护理人员采用三阶段方法寻求治疗。第1阶段-评估;第2阶段-在家外寻求护理;第3阶段-评估治疗反应。在本文中，探讨了三阶段的方法，以确定潜在的干预措施，以针对适当的治疗障碍。社区参与和促进健康、在社区一级提供抗疟药物以及更好地培训卫生工作者了解非疟疾发热性疾病的病因和治疗，可改善获得适当治疗的机会和结果。
BackgroundUniversal access to, and community uptake of malaria prevention and treatment strategies are critical to achieving current targets for malaria reduction. Each step in the treatment-seeking pathway must be considered in order to establish where opportunities for successful engagement and treatment occur. We describe local classifications of childhood febrile illnesses, present an overview of treatment-seeking, beginning with recognition of illness, and suggest how interventions could be used to target the barriers experienced.MethodsQualitative data were collected between September 2010 and February 2011. A total of 12 Focus Group Discussions and 22 Critical Incident Interviews were conducted with primary caregivers who had reported a recent febrile episode for one of their children.Findings and ConclusionThe phrase 'kutentha thupi', or 'hot body' was used to describe fever, the most frequently mentioned causes of which were malungo(translated as 'malaria'), mauka, nyankhwa and (m)tsempho. Differentiating the cause was challenging because these illnesses were described as having many similar non-specific symptoms, despite considerable differences in the perceived mechanisms of illness. Malungo was widely understood to be caused by mosquitoes. Commonly described symptoms included: fever, weakness, vomiting, diarrhoea and coughing. These symptoms matched well with the biomedical definition of malaria, although they also overlapped with symptoms of other illnesses in both the biomedical model and local illness classifications. In addition, malungo was used interchangeably to describe malaria and fever in general. Caregivers engaged in a three-phased approach to treatment seeking. Phase 1-Assessment; Phase 2-Seeking care outside the home; Phase 3-Evaluation of treatment response. Within this paper, the three-phased approach is explored to identify potential interventions to target barriers to appropriate treatment. Community engagement and health promotion, the provision of antimalarials at community level and better training health workers in the causes and treatment of non-malarial febrile illnesses may improve access to appropriate treatment and outcomes.