Abstract：
BACKGROUND: Headache disorders are the largest contributor to all years lived with disability attributed to neurological disorders. In sub-Saharan Africa (SSA), with 1.2 billion inhabitants, headache prevalence is similar to that of Western countries but with widely inadequate access to care. Cost of transport to healthcare facilities hampers access to care, leading to abandonment and low retention. The aim of this observational study in Malawi was to investigate cost of transport and its likely impact on implementation of WHO\'s-Intersectoral Global Action Plan (IGAP) in an HIV+ population also complaining of, and requiring treatment for, an active headache disorder.
METHODS: The study was conducted at the Disease Relief through Excellent and Advanced Means (DREAM) centre in Blantyre, Malawi, in collaboration with the Global Campaign against Headache as an extension of a previous study. Enquiries about distance and costs of travel were added to the previously published questionnaire.
RESULTS: We included 495 consecutive HIV+ patients aged 6-65 years who had been followed for at least 1 year. One-year prevalence of any headache was 76.6%; 28.7% missed at least one appointment because of transport costs. Higher costs of transport were associated with higher probability of missing visits (p < 0.001), while costs were higher for those living in rural areas than for those in urban (p < 0.001).
CONCLUSIONS: Awareness of cost and affordability of transport in SSA may suggest strategies to improve access to headache care. Given the disability attributable to headache, this is necessary if the IGAP strategic objectives and targets are to be achieved.
METHODS: The study was conducted at the Disease Relief through Excellent and Advanced Means (DREAM) centre in Blantyre, Malawi, in collaboration with the Global Campaign against Headache as an extension of a previous study. Enquiries about distance and costs of travel were added to the previously published questionnaire.
RESULTS: We included 495 consecutive HIV+ patients aged 6-65 years who had been followed for at least 1 year. One-year prevalence of any headache was 76.6%; 28.7% missed at least one appointment because of transport costs. Higher costs of transport were associated with higher probability of missing visits (p < 0.001), while costs were higher for those living in rural areas than for those in urban (p < 0.001).
CONCLUSIONS: Awareness of cost and affordability of transport in SSA may suggest strategies to improve access to headache care. Given the disability attributable to headache, this is necessary if the IGAP strategic objectives and targets are to be achieved.
摘要：
背景：头痛障碍是由于神经系统疾病而导致残疾的所有年份的最大原因。在撒哈拉以南非洲（SSA），有12亿居民，头痛的患病率与西方国家相似，但获得护理的机会普遍不足。到医疗机构的运输成本阻碍了获得护理的机会，导致放弃和低保留。马拉维的这项观察性研究的目的是调查运输成本及其对实施世卫组织部门间全球行动计划(IGAP)的可能影响，需要治疗，一种活动性头痛症。
方法：这项研究是在布兰太尔通过优秀和先进手段（DREAM）中心进行的，马拉维,与全球头痛运动合作，作为先前研究的延伸。关于距离和旅行费用的查询被添加到先前发布的问卷中。
结果：我们纳入了495名年龄在6-65岁的连续HIV+患者，随访时间至少1年。任何头痛的一年患病率为76.6％；由于交通费用，28.7％的人至少错过了一次预约。较高的运输成本与较高的错访概率相关(p<0.001)，而生活在农村地区的人的成本高于城市地区的人(p<0.001)。
结论：对SSA中运输的成本和可负担性的认识可能建议改善头痛治疗的策略。鉴于头痛导致的残疾，如果要实现IGAP战略目标和指标，这是必要的。
方法：这项研究是在布兰太尔通过优秀和先进手段（DREAM）中心进行的，马拉维,与全球头痛运动合作，作为先前研究的延伸。关于距离和旅行费用的查询被添加到先前发布的问卷中。
结果：我们纳入了495名年龄在6-65岁的连续HIV+患者，随访时间至少1年。任何头痛的一年患病率为76.6％；由于交通费用，28.7％的人至少错过了一次预约。较高的运输成本与较高的错访概率相关(p<0.001)，而生活在农村地区的人的成本高于城市地区的人(p<0.001)。
结论：对SSA中运输的成本和可负担性的认识可能建议改善头痛治疗的策略。鉴于头痛导致的残疾，如果要实现IGAP战略目标和指标，这是必要的。
