A New Model for Management of Mycetoma in the Sudan
A New Model for Management of Mycetoma in the Sudan
复制标题
DOI：
10.1371/journal.pntd.0003271
复制
发表时间：
2014-10-01
影响因子：
3.8
通讯作者：
Zijlstra, Eduard E.
中科院分区：
文献类型：
--
作者：
Fahal, Ahmed;Mahgoub, El Sheikh;Zijlstra, Eduard E.
足菌肿患者多表现为晚期，这与流行区医疗卫生设施缺乏、健康教育落后、社会经济地位低下有关。在此背景下，设计了一个村级综合病人管理模式，以解决与足菌肿相关的各种问题。该模式于2010年至2013年在苏丹的一个流行病村庄启动。这一模式是在一个前瞻性的，描述性的，以社区为基础的研究，旨在收集流行病学，生态和临床数据，并评估知识，态度和做法（KAP），以设计有效和高效的管理措施。在这项研究中，足菌肿的患病率为14.5/1000居民。患者多为社会经济地位低下的农民、家庭主妇和儿童，未发现明显的危险人群。所有患者均在村里的移动的外科单位进行手术，鼓励患者早期出现小的早期病变，从而获得良好的临床结局。与相思树刺、动物和动物粪便的密切接触、赤脚行走和卫生习惯差可能都是导致该村足菌病发展的原因。在96.3%的研究人群中，足菌肿的知识很差，70%的人对与足菌肿患者和治疗方法的相互作用有适当的态度和信念，49%的人在足菌肿的管理中使用了令人满意的或良好的实践。对足菌肿的知识和行为与年龄有显著相关性。根据KAP和流行病学资料，在该村开展了针对不同目标人群的健康教育活动。在这项研究中采用的综合管理方法是独特的，似乎是成功的，似乎适合作为一个立即干预。从长远来看，建立配备训练有素的保健人员的地方保健设施仍然是一个优先事项。
Patients with mycetoma usually present late with advanced disease, which is attributed to lack of medical and health facilities in endemic areas, poor health education and low socio-economic status. With this background, an integrated patient management model at the village level was designed to address the various problems associated with mycetoma. The model was launched in an endemic village in the Sudan, between 2010 and 2013. This model is described in a prospective, descriptive, community-based study, aimed to collect epidemiological, ecological, and clinical data and to assess knowledge, attitude and practice (KAP) in order to design effective and efficient management measures. In this study, the prevalence of mycetoma was 14.5 per 1,000 inhabitants. The patients were farmers, housewives and children of low socio-economic status, and no obvious risk group was detected. All had surgery performed in a mobile surgical unit in the village which encouraged patients to present early with small early lesion leading to a good clinical outcome. The close contact with the Acacia tree thorns, animals and animal dung, walking bare footed and practising poor hygiene may all have contributed to the development of mycetoma in the village. Knowledge of mycetoma was poor in 96.3% of the study population, 70% had appropriate attitudes and beliefs towards interaction with mycetoma patients and treatment methods, and 49% used satisfactory or good practices in the management of mycetoma. Knowledge and practices on mycetoma were found to be significantly associated with age. Based on the KAP and epidemiological data, several health education sessions were conducted in the village for different target groups. The integrated management approach adopted in this study is unique and appeared successful and seems suitable as an immediate intervention. While for the longer term, establishment of local health facilities with trained health staff remains a priority.