Barriers to prompt and effective treatment of malaria in northern Sri Lanka
Barriers to prompt and effective treatment of malaria in northern Sri Lanka
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DOI：
10.1046/j.1365-3156.2002.00919.x
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发表时间：
2002-09-01
影响因子：
3.3
通讯作者：
Pakianathar, MV
中科院分区：
文献类型：
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作者：
Reilley, B;Abeyasinghe, R;Pakianathar, MV
过去18年来，斯里兰卡北部一直受到武装种族冲突的影响。这对平民流离失所、提供保健服务、该地区保健专业人员人数和基础设施产生了严重影响。斯里兰卡北部的疟疾负担严重，全国不到5%的人口遭受34%的报告病例。卫生保健提供者调查了寻求治疗的行为和被认为是缺乏坚持治疗的结果的治疗失败程度。方法对在门诊就诊的患者进行治疗前和治疗后的访谈和焦点小组访谈。结果共有271人完成了访谈，54.4%的人在出现症状后2天内就诊，91.9%的人在就诊前自行用药，以扑热息痛为主。自我治疗与延迟治疗相关（RR 3.55, CI 1.23-10.24, P =0.002）。在治疗后的访谈中，自我报告的违约率为26.1%。不良反应（57.6%）和症状消失（16.7%）是不完整服药的主要原因。焦点小组表明，对氯喹治疗和预防缺乏信心，对预防方法缺乏热情。许多因素导致疟疾治疗缺乏机会和质量较低：由于战斗缺乏医务人员和设施；对治疗缺乏信心，认为疟疾是一种常规疾病。预防工作需要考虑到某些信念和做法才能取得成功。
BACKGROUND For the past 18 years, northern Sri Lanka has been affected by armed ethnic conflict. This has had a heavy impact on displacement of civilians, health delivery services, number of health professionals in the area and infrastructure. The north of Sri Lanka has a severe malaria burden, with less than 5% of the national population suffering 34% of reported cases. Health care providers investigated treatment-seeking behaviour and levels of treatment failure believed to be the result of lack of adherence to treatment.METHODS Pre- and post-treatment interviews with patients seeking treatment in the outpatient department (OPD) and focus groups.RESULTS A total of 271 persons completed interviews: 54.4% sought treatment within 2 days of the onset of symptoms, and 91.9% self-treated with drugs with prior to seeking treatment, mainly with paracetamol. Self-treatment was associated with delaying treatment (RR 3.55, CI 1.23-10.24, P =0.002). In post-treatment interviews, self-reported default was 26.1%. The main reasons for not taking the entire regimen were side-effects (57.6%) and disappearance of symptoms (16.7%). Focus groups indicated some lack of confidence in chloroquine treatment and prophylaxis, and scant enthusiasm for prevention methods.CONCLUSIONS A number of factors contribute to a lack of access and a lower quality of care for malaria: lack of medical staff and facilities because of the fighting; lack of confidence in treatment, and perception of malaria as a routine illness. Prevention efforts need to take into account certain beliefs and practices to be successful.