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目的探讨改进边远贫困山区少数民族疟疾诊断和治疗可及性策略。方法免费提供疟疾诊断和治疗;培训当地本民族的村疟防员制作发热病人血片,为疟疾病人送药并监督服药,开展以入户为主的面对面健康教育。结果村卫生人员与居民比从干预前的1∶1116.75改变为干预后的1∶248.17;发热开始24h内求医病人比例,使用公共卫生机构发热病人比例和对疟防服务满意村民比例分别从基线的23.03%(95%CI=18.81～27.71),56.94%(95%CI=52.55～61.25)和82.65%(95%CI=81.23～86.31)提高到干预后评估调查的86.95%(95%CI=68.47～96.57),91.30%(95%CI=74.13～98.51)和96.81%(95%CI=93.08～98.82)。结论改进当地经济、地理、信息和文化方面疟疾诊治可及性,与其他措施一起有效地降低了当地疟疾的发病和流行程度。
Objective To explore strategies to improve malaria diagnosis and treatment accessibility in remote and impoverished mountainous areas. Methods The malaria diagnosis and treatment were provided free of charge. The village malaria prevention staff of local ethnic groups were trained to produce blood film of febrile patients, drug delivery and supervision of malaria patients, and face-to-face health education with home-based approach. Results The proportion of village health workers and residents changed from 1:1116.75 before intervention to 1:248.17 after intervention; the proportion of patients seeking treatment in the first 24h of fever, the proportion of patients using public health institutions with fever and the proportion of villagers who were satisfied with malaria prevention were respectively decreased from baseline (95% CI = 18.81 ~ 27.71), 56.94% (95% CI = 52.55 ~ 61.25) and 82.65% (95% CI = 81.23 ~ 86.31) after intervention. 68.47 ~ 96.57), 91.30% (95% CI = 74.13 ~ 98.51) and 96.81% (95% CI = 93.08 ~ 98.82). Conclusions Improving malaria diagnosis and treatment accessibility in the local economy, geography, information and culture, together with other measures, has effectively reduced the incidence and prevalence of malaria in the area.