背景:血吸虫病构成了严重的公共卫生问题和社会挑战,影响了超过2.4亿人,大多数人生活在撒哈拉以南非洲。世界卫生组织(WHO)建议吡喹酮(PZQ)通过定期大规模药物管理(MDA)进行药物治疗,并进行社会动员,健康教育和敏化。通过社会动员、健康教育和宣传,对PZQ的需求必然会增加,特别是在地方性社区的情况下。然而,尚不清楚在没有PZQMDA的情况下,社区去哪里进行PZQ治疗。当MDA延迟时,我们探索了乌干达西部阿尔伯特湖沿岸社区中有关血吸虫病治疗的寻求健康行为,通报对实现世卫组织2030年75%覆盖率和吸收目标的实施政策的审查。
方法:我们在Kagadi和Ntoroko进行了一项基于社区的定性研究,2020年1月和2月的地方性社区。我们采访了12个人:当地领导人,村卫生队,和卫生工作者,并与251名有意选出的社区成员举行了28次焦点小组讨论。使用主题分析模型对数据的音频记录进行转录和分析。
结果:一般来说,参与者很少从政府医院和健康中心II寻求血吸虫病相关体征和症状的药物治疗,III和IV。相反,他们依赖社区志愿者,如VHT,私人设施,比如附近的诊所和药店,或传统来源(例如巫医和中医)。结果表明,影响人们从政府以外的其他来源寻求治疗的因素是:政府医疗机构中没有PZQ药物;卫生工作者对患者的消极态度;距离政府医院和医疗机构很远;道路简陋且无法通行;与药物相关的费用;以及对PZQ药物的负面看法。
结论:PZQ的可用性和可及性似乎是一个巨大的挑战。卫生系统以及与社区有关的和社会文化因素进一步阻碍了PZQ的采用。因此,有必要使血吸虫病药物治疗和服务更接近流行社区,与PZQ一起存放附近的设施,并鼓励地方社区服用该药物。需要进行情境化的提高认识活动,以揭穿围绕该药物的神话和误解。
Schistosomiasis poses a serious public health problem and a social challenge affecting over 240 million people, the majority of whom live in sub-Saharan Africa. The World Health Organization (WHO) recommends praziquantel (PZQ) drug treatment through regular mass drug administration (MDA) accompanied by social mobilisation and health education and sensitisation. With social mobilisation and health education and sensitisation, there is bound to be increased demand for the PZQ, especially in the
case of endemic communities. However, it is not clear where communities go for PZQ treatment in the absence of PZQ MDA. We explored the health-seeking behaviours regarding schistosomiasis treatment among communities along Lake Albert in Western Uganda when MDA had delayed, to inform a review of the implementation policy for the achievement of the WHO\'s 2030 target of 75% coverage and uptake.
We conducted a community-based qualitative study in Kagadi and Ntoroko, an endemic community in January and February 2020. We interviewed 12 individuals: local leaders, village health teams, and health workers, and conducted 28 focus group discussion sessions with 251 purposively selected community members. The audio recordings of the data were transcribed and analyzed using a thematic analysis model.
Generally, participants seldom seek medication for schistosomiasis-related signs and symptoms from government hospitals and health centres II, III and IV. Instead, they rely on community volunteers such as VHTs, private facilities, such as clinics and drug shops nearby, or traditional sources (e.g. witch doctors and herbalists). Results show that factors influencing people to seek treatment from sources other than the government are: the absence of PZQ drugs in the government health facility; health workers\' negative attitude towards patients; long distances to the government hospitals and health facilities; poor and inaccessible roads; medication-related costs; and negative perceptions of the PZQ drug.
Availability and accessibility of PZQ seem to be a big challenge. PZQ uptake is further hampered by health systems and community-related and socio-cultural factors. Thus there is a need to bring schistosomiasis drug treatment and services closer to endemic communities, stock nearby facilities with PZQ and encourage endemic communities to take the drug. Contextualised awareness-raising campaigns are needed to debunk myths and misconceptions surrounding the drug.