Household cost of malaria overdiagnosis in rural Mozambique
Household cost of malaria overdiagnosis in rural Mozambique
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DOI：
10.1186/1475-2875-7-33
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发表时间：
2008-02-18
期刊：
影响因子：
3
通讯作者：
Bates, Imelda
中科院分区：
文献类型：
--
作者：
Hume, Jen C. C.;Barnish, Guy;Bates, Imelda
背景：据估计，在撒哈拉以南非洲，超过70%的疑似疟疾患者在家中诊断和处理他们的疾病，而不转诊到正式的卫生诊所。在那些确实去正规卫生诊所就诊的患者中，疟疾过度诊断率估计在30%到70%之间。方法：本文详细介绍了一项观察性队列研究，记录了莫桑比克农村地区两家医疗保健机构因疟疾过度诊断而重复咨询的数量和成本。对临床诊断为疟疾的成人和儿童进行了为期21天的跟踪调查，以评估被误诊的疟疾患者与确诊的疟疾患者(通过血片阳性读数确定)的治疗方案、症状、重复就诊次数和费用。结果：仅根据临床症状进行诊断，误诊了23%的儿童(16岁)和31%的成年疟疾患者。在首次出现症状后的三周内，成人的症状持续(p=0.023)，新的症状发展(p<；0.001)多于儿童。与那些真正患有疟疾的人相比，被过度诊断为疟疾的成年人有更多的重复就诊(67%比46%，p=0.01-0.06)。被正确诊断为疟疾的患者和被错误诊断为疟疾的患者之间的费用没有差异。在三周内，就诊一次的患者的平均费用为0.28美元，就诊3次的患者为0.76美元，在最贫穷的人群中比例最高(p<；0.001)。结论：过度诊断疟疾会导致成年患者就诊的次数更多，相关费用也更高。此外，很明显，最贫穷的个人为他们的医疗保健支付的比例要高得多，这使得他们得到的治疗必须是正确的，以防止浪费有限的经济资源。因此，在初级一级投资进行准确的疟疾诊断和适当的管理，对于改善健康结果和减少贫穷至关重要。
Background: It is estimated that over 70% of patients with suspected malaria in sub-Saharan Africa, diagnose and manage their illness at home without referral to a formal health clinic. Of those patients who do attend a formal health clinic, malaria overdiagnosis rates are estimated to range between 30-70%.Methods: This paper details an observational cohort study documenting the number and cost of repeat consultations as a result of malaria overdiagnosis at two health care providers in a rural district of Mozambique. 535 adults and children with a clinical diagnosis of malaria were enrolled and followed over a 21 day period to assess treatment regimen, symptoms, number and cost of repeat visits to health providers in patients misdiagnosed with malaria compared to those with confirmed malaria (determined by positive bloodfilm reading).Results: Diagnosis based solely on clinical symptoms overdiagnosed 23% of children (< 16y) and 31% of adults with malaria. Symptoms persisted (p = 0.023) and new ones developed (p < 0.001) in more adults than children in the three weeks following initial presentation. Adults overdiagnosed with malaria had more repeat visits (67% v 46%, p = 0.01-0.06) compared to those with true malaria. There was no difference in costs between patients correctly or incorrectly diagnosed with malaria. Median costs over three weeks were $0.28 for those who had one visit and $0.76 for >= 3 visits and were proportionally highest among the poorest (p < 0.001)Conclusion: Overdiagnosis of malaria results in a greater number of healthcare visits and associated cost for adult patients. Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources. Thus, investment in accurate malaria diagnosis and appropriate management at primary level is critical for improving health outcomes and reducing poverty.