Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda
Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda
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DOI：
10.1186/1475-2875-9-203
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发表时间：
2010-07-13
期刊：
影响因子：
3
通讯作者：
Kallander, Karin
中科院分区：
文献类型：
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作者：
Mukanga, David;Tibenderana, James K.;Kallander, Karin
背景：许多疟疾流行国家计划在社区一级采用青蒿素联合疗法（ACT），利用社区卫生工作者（CHWs）治疗无并发症的疟疾。依靠推定诊断使用ACT可能导致过度使用、费用增加和耐药性上升。使用快速诊断测试（RDTs）可以解决这些挑战，但前提是社区接受卫生工作者使用这些测试。本研究评估了社区对乌干达卫生保健员（当地称为社区药物分销商（cmd））使用RDTs的接受程度。方法：研究在Iganga区进行，采用10次与社区卫生工作者和5岁以下儿童照料者的焦点小组讨论（fgd）和10次与卫生工作者和社区领导人的关键信息提供者访谈（KIIs）。使用预先设计的FGD和KII指南收集数据。显性内容分析用于探讨对CMDs的信任和信心问题，与儿童抽血相关的耻辱感，社区对CMDs使用RDTs的意愿，以及CMDs预计将面临的挑战。结果：社区社区信任社区疟疾防治人员，因为他们致力于志愿服务、可获得性以及所提供的抗疟疾药物的有效性。一些社区成员表示，他们担心采集的血液可能被用于艾滋病毒检测，这一过程可能会使儿童感染艾滋病毒，而且血液样本可能被用于巫术。社区接受cmd的教育水平很重要，社区欢迎使用RDTs，因为cmd是经过培训和支持的。预计慢性病患者将面临的挑战包括运送患者随访和挑选用品，成年人要求进行检测，以及护理人员坚持让他们的孩子接受治疗而不是转诊。结论：社区成员很可能接受社区医务人员使用RDTs，因为社区医务人员得到了适当的培训，并得到了定期的技术监督和后勤支持。需要制定一项精心设计的行为改变传播战略，以应对预期的规划挑战以及社区对抽血的恐惧和耻辱。正规教育水平可能必须成为选择CMD进入部署RDTs的方案的一个标准。
Background: Many malarious countries plan to introduce artemisinin combination therapy (ACT) at community level using community health workers (CHWs) for treatment of uncomplicated malaria. Use of ACT with reliance on presumptive diagnosis may lead to excessive use, increased costs and rise of drug resistance. Use of rapid diagnostic tests (RDTs) could address these challenges but only if the communities will accept their use by CHWs. This study assessed community acceptability of the use of RDTs by Ugandan CHWs, locally referred to as community medicine distributors (CMDs).Methods: The study was conducted in Iganga district using 10 focus group discussions (FGDs) with CMDs and caregivers of children under five years, and 10 key informant interviews (KIIs) with health workers and community leaders. Pre-designed FGD and KII guides were used to collect data. Manifest content analysis was used to explore issues of trust and confidence in CMDs, stigma associated with drawing blood from children, community willingness for CMDs to use RDTs, and challenges anticipated to be faced by the CMDs.Results: CMDs are trusted by their communities because of their commitment to voluntary service, access, and the perceived effectiveness of anti-malarial drugs they provide. Some community members expressed fear that the blood collected could be used for HIV testing, the procedure could infect children with HIV, and the blood samples could be used for witchcraft. Education level of CMDs is important in their acceptability by the community, who welcome the use of RDTs given that the CMDs are trained and supported. Anticipated challenges for CMDs included transport for patient follow-up and picking supplies, adults demanding to be tested, and caregivers insisting their children be treated instead of being referred.Conclusion: Use of RDTs by CMDs is likely to be acceptable by community members given that CMDs are properly trained, and receive regular technical supervision and logistical support. A well-designed behaviour change communication strategy is needed to address the anticipated programmatic challenges as well as community fears and stigma about drawing blood. Level of formal education may have to be a criterion for CMD selection into programmes deploying RDTs.