Malaria risk and access to prevention and treatment in the paddies of the Kilombero Valley, Tanzania
Malaria risk and access to prevention and treatment in the paddies of the Kilombero Valley, Tanzania
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DOI：
10.1186/1475-2875-7-7
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发表时间：
2008-01-09
期刊：
影响因子：
3
通讯作者：
Mshinda, Hassan
中科院分区：
文献类型：
--
作者：
Hetzel, Manuel W.;Alba, Sandra;Mshinda, Hassan
背景：Kilombero山谷是坦桑尼亚东南部疟疾高发的农业区。这个山谷的季节性洪水有利于疟疾的传播。在农作季节，许多家庭搬到遥远的农田（斯瓦希里语的shamba），在肥沃的河漫滩上种植水稻。在香巴，人们在临时避难所住了几个月，远离最近的医疗服务。这项研究评估了季节性迁移到偏远地区对疟疾风险和寻求治疗行为的影响。方法：对随机选取的约100户农户进行了为期6个月的纵向研究。每月对每个家庭进行访问，并记录家庭成员的下落、野外活动、发烧病例和最近发烧发作的治疗情况。结果：与村庄相比，香巴的发烧发病率较低，搬到香巴并不会增加发烧发作的风险。1-4岁的儿童，通常花相当多的时间和他们的看护人在香巴上，比成人更容易发烧（优势比= 4.47,95%置信区间2.35-8.51）。田间蚊帐的保护效果非常好（使用率为98%），但家中储存抗疟药的情况并不常见。尽管距离卫生服务中心很远，但55.8%（37.9-72.8）的发热病例在卫生机构接受治疗，而在家治疗的情况较少见（37%,17.4-50.5）。结论：生活在香巴中似乎不会导致更高的发烧风险。卫生机构使用蚊帐和治疗发烧反映了对疟疾的认识。无法在田间获得药物可能有助于减少不合理使用药物，但可能对贫困农户造成额外负担。需要采取综合办法，改善获得治疗的机会，同时确保合理使用药物和保护脆弱的生计。
Background: The Kilombero Valley is a highly malaria-endemic agricultural area in south-eastern Tanzania. Seasonal flooding of the valley is favourable to malaria transmission. During the farming season, many households move to distant field sites (shamba in Swahili) in the fertile river floodplain for the cultivation of rice. In the shamba, people live for several months in temporary shelters, far from the nearest health services. This study assessed the impact of seasonal movements to remote fields on malaria risk and treatment-seeking behaviour.Methods: A longitudinal study followed approximately 100 randomly selected farming households over six months. Every household was visited monthly and whereabouts of household members, activities in the fields, fever cases and treatment seeking for recent fever episodes were recorded.Results: Fever incidence rates were lower in the shamba compared to the villages and moving to the shamba did not increase the risk of having a fever episode. Children aged 1-4 years, who usually spend a considerable amount of time in the shamba with their caretakers, were more likely to have a fever than adults (odds ratio = 4.47, 95% confidence interval 2.35-8.51). Protection with mosquito nets in the fields was extremely good (98% usage) but home-stocking of antimalarials was uncommon. Despite the long distances to health services, 55.8% (37.9-72.8) of the fever episodes were treated at a health facility, while home-management was less common (37%, 17.4-50.5).Conclusion: Living in the shamba does not appear to result in a higher fever-risk. Mosquito nets usage and treatment of fever in health facilities reflect awareness of malaria. Inability to obtain drugs in the fields may contribute to less irrational use of drugs but may pose an additional burden on poor farming households. A comprehensive approach is needed to improve access to treatment while at the same time assuring rational use of medicines and protecting fragile livelihoods.