背景:疟疾是一种传染病,到2030年,在90个流行国家中的至少35个已成为全球目标。大多数成功的消除疟疾国家方案都让私营卫生部门参与努力,文档,调查,提供有效的治疗,和后续案件。然而,严格的研究表明,埃塞俄比亚正规私营卫生部门的医疗保健提供者遵守国家疟疾诊断和治疗指南的证据有限,从疟疾控制到消除阶段。这项研究的目的是调查和解释在埃塞俄比亚西北部正规私人医疗机构工作的医疗保健提供者对疟疾诊断和治疗指南的遵守程度。
方法:在埃塞俄比亚的WestGojjam地区进行了解释性的顺序混合方法设计。从在11个私营营利性医疗机构中服务的成人无并发症疟疾门诊患者的1650份医疗记录中提取了定量数据。此外,使用定性的方法,对医疗保健提供者进行了33次深度访谈(IDI)。所有采访都是录音,逐字转录,并使用八个步骤进行分析。
结果:在1650例成人门诊疑似疟疾病例中,使用显微镜对80.6%(1330/1650)进行了屏幕测试,其余19.4%(320/1650)使用多物种快速诊断测试(RDT)进行了测试。因此,结果显示,私营医疗服务提供者普遍遵守诊断指南.此外,在跟进并排除其他发烧原因后,4.1%(56/1376)的患者临床诊断为无并发症的疟疾。尽管如此,私营医疗保健提供者坚持疟疾确诊病例治疗指南的比例为20.9%(69/330).此外,1320例(95.9%)实验室检查结果阴性的成人门诊患者未接受治疗。医疗服务提供者对疟疾指南的次优依从性的一些确定的决定因素是供应中断和缺乏推荐的抗疟疾药物,缺乏质量保证的实验室用品,对国家标准的建议知之甚少。
结论:私营医疗保健提供者坚持普遍的寄生虫学诊断,提供全面的咨询,并将患者与社区卫生工作者联系起来。此外,几乎所有实验室阴性患者均未接受抗疟疾药物治疗.然而,只有五分之一的确诊患者接受了符合国家指南建议的治疗.通过建立双赢的公私混合伙伴关系模式的协作功能,可以改善整个埃塞俄比亚的疟疾控制和消除工作。此外,在卫生信息系统中包括私营卫生部门的数据可以显示实际的疟疾负担,并使用这些信息来提高对疟疾诊断的依从性,治疗,以及在目标消除时代内的报告标准。因此,建议建立私营医疗保健提供者的能力,并确保私营卫生部门设施中提供所有国家推荐的药物和用品,以提高服务质量。
BACKGROUND: Malaria is an infectious disease which has been globally targeted for elimination in at least 35 of 90 endemic countries by 2030. Most successful malaria elimination country programmes have engaged the private health sector in an effort to identify, document, investigate, provide effective treatment, and follow-up cases. However, there has been limited rigorous research showing evidence of adherence among healthcare providers of the formal private health sector to national malaria diagnosis and treatment guidelines in Ethiopia, starting from malaria control to elimination phases. The aims of this study were to investigate and explain the level of adherence to malaria diagnosis and treatment guidelines among healthcare providers working in formal private health facilities in north-western Ethiopia.
METHODS: An explanatory sequential mixed method design was conducted in the West Gojjam Zone of Ethiopia. Quantitative data were extracted from 1650 medical records of adult uncomplicated malaria outpatients served in 11 private-for-profit health facilities. In addition, using a qualitative approach, 33 in-depth interviews (IDIs) with healthcare providers were conducted. All interviews were audio-recorded, transcribed verbatim, and analysed using eight steps.
RESULTS: Of 1650 suspected malaria cases in adult outpatients, 80.6% (1330/1650) were screen tested using microscopy and the remainder 19.4% (320/1650) were tested using multispecies rapid diagnosis tests (RDTs). Hence, the results revealed that private healthcare providers universally adhered to diagnosis guidelines. In addition, after following-up and excluding other causes of fever, 4.1% (56/1376) patients were clinically diagnosed with uncomplicated malaria. Despite this, the proportion of private healthcare provider adherence with confirmed malaria
case treatment guidelines was 20.9% (69/330). In addition, 1320 (95.9%) of adult outpatients with negative laboratory results were not treated. Some of the identified determinant factors for sub-optimal adherence of healthcare providers to malaria guidelines were interruptions in supply and lack of availability of recommended anti-malarial drugs, lack of availability of quality assured laboratory supplies, and poor knowledge of the recommendations of the national standards.
CONCLUSIONS: Private healthcare providers adhered to universal parasitological diagnosis, providing comprehensive counseling, and linking patients with community health workers. In addition, almost all laboratory negative patients were not treated with anti-malarial drugs. However, only one-fifth of confirmed patients were treated in line with national guideline recommendations. Malaria control and elimination efforts across Ethiopia could be improved through establishing a collaborative function of a win-win public private mix partnership model. In addition, including the data of the private health sector in the health information system could show real malaria burden and use the information to improve the adherence to malaria diagnosis, treatment, and reporting standards within the targeted era of elimination. Therefore, building the capacity of private healthcare providers and ensuring the availability of all nationally recommended drugs and supplies in private health sector facilities is recommended to improve the quality of services.