Suchergebnisse

The daunting health challenges now confronting Africa, and the rest of the developing world, have been well publicized. Malaria, HIV/AIDS, tuberculosis, malnutrition, anemia: all devastating epidemics whose effects are multiplied by conditions of poverty. In Tanzania, however, recent experience and research are providing cause for optimism. In 1993, the World Development Report suggested that mortality rates could be significantly reduced if resources were directed more in line with local "burden of disease." The TEHIP program was founded to test this idea. After a decade of research and exper

En 1993, le Rapport sur le développement dans le monde laissait entendre que l'affectation proportionnelle des budgets de santé à la « charge de morbidité » locale pourrait abaisser considérablement les taux de mortalité et de morbidité. Comme la première édition de La réforme du système de santé en fait état, le Projet d'interventions essentielles en santé en Tanzanie (PIEST) foisonne d'arguments puissants confirmant cette hypothèse. Ainsi, dans les deux districts qui ont servi de terrains d'essai au PIEST, de modestes augmentations du financement et un profond remaniement institutionnel ont

BACKGROUND: Once malaria occurs, deaths can be prevented by prompt treatment with relatively affordable and efficacious drugs. Yet this goal is elusive in Africa. The paradox of a continuing but easily preventable cause of high mortality raises important questions for policy makers concerning care-seeking and access to health systems. Although patterns of care-seeking during uncomplicated malaria episodes are well known, studies in cases of fatal malaria are rare. Care-seeking behaviours may differ between these groups. METHODS: This study documents care-seeking events in 320 children less than five years of age with fatal malaria seen between 1999 and 2001 during over 240,000 person-years of follow-up in a stable perennial malaria transmission setting in southern Tanzania. Accounts of care-seeking recorded in verbal autopsy histories were analysed to determine providers attended and the sequence of choices made as the patients' condition deteriorated. RESULTS: As first resort to care, 78.7% of malaria-attributable deaths used modern biomedical care in the form of antimalarial pharmaceuticals from shops or government or non-governmental heath facilities, 9.4% used initial traditional care at home or from traditional practitioners and 11.9% sought no care of any kind. There were no differences in patterns of choice by sex of the child, sex of the head of the household, socioeconomic status of the household or presence or absence of convulsions. In malaria deaths of all ages who sought care more than once, modern care was included in the first or second resort to care in 90.0% and 99.4% with and without convulsions respectively. CONCLUSIONS: In this study of fatal malaria in southern Tanzania, biomedical care is the preferred choice of an overwhelming majority of suspected malaria cases, even those complicated by convulsions. Traditional care is no longer a significant delaying factor. To reduce mortality further will require greater emphasis on recognizing danger signs at home, prompter care-seeking, improved quality of care at health facilities and better adherence to treatment.