Educational intervention increased referrals to allopathic care by traditional healers in three high HIV-prevalence rural districts in Mozambique.
Educational intervention increased referrals to allopathic care by traditional healers in three high HIV-prevalence rural districts in Mozambique.
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DOI：
10.1371/journal.pone.0070326
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Gaspar F
中科院分区：
文献类型：
--
作者：
Audet CM;Salato J;Blevins M;Amsalem D;Vermund SH;Gaspar F
临床服务的延迟使用阻碍了莫桑比克良好的临床结果。开始接受传统治疗师护理的患者的护理会被延迟；患有人类免疫缺陷病毒（HIV）或结核病等疾病的患者很少被及时转诊至卫生系统。我们对传统治疗师进行了事前教育干预，评估了赞比西亚省三个农村地区的治疗师转诊率和艾滋病毒知识。干预前的中位每月转诊率为 0.25 名患者（四分位数范围 [IQR]：0–0.54），而干预后的转诊率为 0.34 名患者（IQR：0–0.71），增加了 35%（p = 0.046）。干预前 4 个月的 HIV 知识得分中位数为 67%（IQR：59-78），干预后 2.5 个月的得分中位数为 81%（IQR：74-89）（p<0.001）。 111 名治疗师将 127 名成人、36 名孕妇和 188 名儿童转介至医疗机构。转诊患者最有可能被诊断患有支气管肺炎（20% 成人；13% 儿童）和/或疟疾（15% 成人；37% 儿童）。在转介的 315 名非孕妇中，3.5% 接受了艾滋病毒检测，2.5% 接受了结核病检测。我们聘请传统治疗师并取得了一些成功；转诊率较低，但干预后有所增加。一旦出现在诊所，患者很少接受艾滋病毒或结核病检测，尽管症状表明需要进行筛查。我们发现，通过传统治疗师的廉价干预，转诊率有所提高，这是一种可行且经济有效的引导患者前往医疗机构的方法。然而，在预期产生重大影响之前，诊所内的质量改进是必要的。
Delayed uptake of clinical services impedes favorable clinical outcomes in Mozambique. Care is delayed among patients who initiate care with traditional healers; patients with conditions like human immunodeficiency virus (HIV) or tuberculosis are rarely referred to the health system in a timely fashion. We conducted a pre-post educational intervention with traditional healers, assessing healer referral rates and HIV knowledge in three rural districts in Zambézia Province. The median monthly referral rate prior to the intervention was 0.25 patients (interquartile range [IQR]: 0–0.54) compared with a post-intervention rate of 0.34 patients (IQR: 0–0.71), a 35% increase (p = 0.046). A median HIV knowledge score of 67% (IQR: 59–78) was noted 4-months pre-intervention and a median score of 81% (IQR: 74–89) was recorded 2½ months post-intervention (p<0.001). One hundred and eleven healers referred 127 adults, 36 pregnant women, and 188 children to health facilities. Referred patients were most likely to be diagnosed with bronchopneumonia (20% adults; 13% children) and/or malaria (15% adults; 37% children). Of 315 non-pregnant persons referred, 3.5% were tested for HIV and 2.5% were tested for tuberculosis. We engaged traditional healers with some success; referral rates were low, but increased post-intervention. Once seen in the clinics, patients were rarely tested for HIV or tuberculosis, though symptoms suggested screening was indicated. We found increased referral rates through an inexpensive intervention with traditional healers, a viable, cost-effective method of directing patients to health facilities. However, quality improvement within the clinics is necessary before a substantial impact can be expected.
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DOI：
10.1086/655127
发表时间：
2010-08-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Fitzwater SP;Caviedes L;Gilman RH;Coronel J;LaChira D;Salazar C;Saravia JC;Reddy K;Friedland JS;Moore DA
通讯作者：
Moore DA
DOI：
10.1080/17290376.2012.665257
发表时间：
2012-03-01
影响因子：
1.1
作者：
Audet, Carolyn M.;Sidat, Mohsin;Vermund, Sten H.
通讯作者：
Vermund, Sten H.
DOI：
10.1080/09540129947875
发表时间：
1999-08-01
影响因子：
1.7
作者：
Burnett, A;Baggaley, R;Bennett, J
通讯作者：
Bennett, J
DOI：
10.1086/651477
发表时间：
2010-05-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Bassett IV;Walensky RP
通讯作者：
Walensky RP
影响因子：
5.9
作者：
Furin, Jennifer
通讯作者：
Furin, Jennifer