Over 1 billion通过大规模药物管理运动给予了被忽视的热带疾病的治疗方法。大众药物管理局(MDA)的成功取决于高覆盖范围,诸如此类的大量覆盖范围为希望提供了希望。但是,谁实际上直接向地方性地区的人管理毒品呢?
Most MDA programmes use lay volunteers in endemic communities to implement treatment. MDA doesn’t require diagnosis and the drugs used to treat schistosomiasis, soil transmitted helminthiases (STHs) and lymphatic filariasis are safe. The community medicine distributors (CMD) are usually elected by local leaders and the people donate their time and efforts to this essential health intervention. The CMDs usually receive training (and a small travel reimbursement) from their local Ministry of Health, but otherwise are unpaid. These CMDs are critical to the success of MDA. Therefore, understanding what factors influence the number of treatments individual CMDs are able to distribute is important for improving village coverage, but data at this fine scale is very difficult to collect and interpret.
最近的研究published inBMC医学profiled individual CMDs and the factors that influenced the number of treatments they administered. In a Herculean effort, the scientists tracked treatment by CMDs in 31 villages over a month during a routine MDA. In Uganda, two CMDs per village are tasked with treating all eligible individuals (classified as community members that are five years or older in this setting). CMDs are trained to move door-to-door with the treatment rather than administer at a central point.
The villages surveyed were all in Mayuge District in Eastern Uganda, a known high endemicity area for several neglected tropical diseases. All villages were within 5km of Lake Victoria and all were eligible for community-based MDA. The villages had received at least 10 annual rounds of community based MDA at the time of the study. The prevalence of three neglected tropical diseases in community members over the age of 5 years ranged from low for淋巴丝虫病(5%)到高(schistosomiasis (36%) and hookworm (41%)).
为了评估CMD的治疗率,对每个村庄的40个家庭进行了随机采样,以调查治疗覆盖范围。最后,对这项研究进行了调查的1238个患有6776人的家庭。询问家庭中的个人是否已提供药物,CMD向他们提供了该药物以及是否摄入药物。还收集了每个CMD的数据,包括但不限于利他主义,社会经济指标和社会网络凝聚力的指标。
Over all the individuals surveyed, only 45% of people eligible were treated during MDA. Praziquantel (for schistosomiasis) was offered more than albendazole and ivermectin (hookworm and lymphatic filariasis). Each CMD treats about 26% of eligible individuals within a village, which is below current recommendations for coverage.
与人口中位年龄相比,该地区的CMD平均年龄较大。许多CMD已发挥了8年的成绩,表明该志愿者职位的营业额非常低。尽管有很多渔民,但许多CMD是农民(75%)这些人群. CMDs were often selected by local council members, rather than nominated by the community (which is the national recommendation).
Among the CMDs, there was a lot of variation in treatment rates. So what predicts a high-performing CMD? Out of 25 characteristics of the CMDs that were collected, only 7 of these were shown to correlate with their effectiveness. When CMDs get friends to help with MDA, this increases the number of eligible individuals they treat. Also fisherfolk/fishmonger occupations increased the treatment in the community. Female CMDs were found to treat less of the eligible community members than men. Additionally, several social network metrics were important in increasing treatment. Interestingly, if a CMD was appointed by a local council, they treated less people than if they were elected during a community meeting.
这项研究强调,提高CMD治疗率对于改善覆盖范围至关重要。这项研究除了其他研究之外,还发现受体社区中的障碍很少,发现CMD特征在治疗率中很重要。诸如此研究的更多工作,尤其是在不同的环境中,将有助于介绍使CMD有效的原因。
Focusing on ways to improve individual CMD treatment rates will have cascading impacts on local morbidity and transmission and should be a focus of evaluation and monitoring studies.
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