Malaria clinics in Mae Sot, Thailand: factors affecting clinic attendance.
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Clinics of the Anti-Malaria Program of Thailand play an important part in the control of malaria morbidity and mortality, treating over 60% of reported cases yearly. Interviews were conducted both with attenders at three clinics in Mae Sot District and among those reporting malaria illness but not attending. Distance travelled to the clinic, costs of travel and frequency of other treatment prior to clinic attendance were all highest among patients at the large centralized clinic, moderate in a peripheral fixed clinic, and lowest in a village-based mobile clinic. Reported length of illness prior to attendance was similar for all three clinics. As many as 91% of villagers interviewed chose not to treat their illness in a malaria clinic. These non-attenders reported longer illness time and higher expenditures on treatment than clinic patients. Provision of village-based clinics can improve access. However, the widespread reliance on non-Program treatment of malaria suggests the need for policies to address these alternative therapeutic modes.Keywords:
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Clinics of the Anti-Malaria Program of Thailand play an important part in the control of malaria morbidity and mortality, treating over 60% of reported cases yearly. Interviews were conducted both with attenders at three clinics in Mae Sot District and among those reporting malaria illness but not attending. Distance travelled to the clinic, costs of travel and frequency of other treatment prior to clinic attendance were all highest among patients at the large centralized clinic, moderate in a peripheral fixed clinic, and lowest in a village-based mobile clinic. Reported length of illness prior to attendance was similar for all three clinics. As many as 91% of villagers interviewed chose not to treat their illness in a malaria clinic. These non-attenders reported longer illness time and higher expenditures on treatment than clinic patients. Provision of village-based clinics can improve access. However, the widespread reliance on non-Program treatment of malaria suggests the need for policies to address these alternative therapeutic modes.
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A preoperative clinic for gynaecological surgery was introduced primarily to provide counselling but with access to multidisciplinary support. Initial results showed a substantial reduction in the postoperative hospitalisation period and a significant improvement in attendance rates.
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A set of data collection tools, STATA .do processing scripts, and resultant datasets produced as part of the Treatment Kit (LTK) Project, a study funded to evaluate the impact of a school-based programme of malaria diagnosis and treatment (malaria case management) as part of a wider school first-aid kit exploring school attendance, health and education outcomes. The study conducted a cluster randomized controlled trial in 58 primary schools in TA Chikowi, Zomba district of southern Malawi. The intervention, implemented between 2013-2015 in 29 randomly selected schools from the total of 58 schools, comprised providing free-of-charge malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) to primary schools to be used by trained teachers to diagnose and treat uncomplicated malaria, as part of basic first aid kits known as Learner Treatment Kits (LTKs). The primary outcome was school attendance, assessed through teacher-recorded school attendance registers and periodic spot checks. Secondary outcomes included prevalence of Plasmodium spp. infection, anaemia, educational performance, self-reported child wellbeing, and health seeking behaviour. The trial is registered with ClinicalTrials.gov, NCT02213211.
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Objective:To analyze the clinical characteristics of Kawasaki disease in the infants less than 6 months old which lead to early observation and diagnosis of KD in infants and decrease the incidence of coronary complications.Methods:Retrospective analysis of clinic data of 26 KD infants less than 6 months old from January 2005 to May 2010 in our hospital were done.Results:The clinic characteristics of KD in infants less than 6 months old were atypical,most of them presented incompletely and the coronary artery always were injured.Long time was spent to diagnose and many were misdiagnosed.Conclusion:It is the only way for early diagnosis KD in infants that coronary artery was monitored in suspicious patients.Infants less than 6 months old should be suspicious of KD who had fever lasting for at least 5 days with unknown reasons and the treatment is not efficient.It could lead to early diagnosis and improve prognosis.
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Caretakers of children (< 10 years of age) were questioned about management of pediatric malarial fever episodes in a nation-wide knowledge, attitudes, and practices survey conducted in Malawi. A total of 1,531 households in 30 randomly selected clusters of 51 households each were sampled and interviewed. Overall 557 caretakers reported a fever in their child in the previous 2 weeks; 43%-judged the illness as severe. Fifty-two percent of caretakers brought their febrile children to clinic. Clinic attendance was positively correlated with young age of the child (< 4 years), severe illness, and higher socioeconomic status. Seventy-four percent of clinic attenders gave their child an antimalarial; in contrast, only 42% of those not attending clinic gave an antimalarial. Optimal therapy (administration of an antimalarial promptly and at the proper dosage) was received by only 7% of febrile children. Children taken to clinic were twice as likely to receive optimal therapy as were non-attenders. Identification of critical points in the optimal therapy algorithm and characteristics of caretakers linked with sub-optimal therapy may help malaria control programs target specific groups and health education messages to improve treatment of malaria fever episodes.Caretakers of children (10 years of age) were questioned about management of pediatric malarial fever episodes in a nation-wide knowledge, attitudes, and practices survey conducted in Malawi. A total of 1531 households in 30 randomly selected clusters of 51 households each were sampled and interviewed. Overall 557 caretakers reported a fever in their child in the previous 2 weeks; and 43% judged the illness severe. 289 (52%) of caretakers brought their febrile children to clinic. Clinic attendance was linked with the age of the child, with younger children (4 years of age) being significantly more likely to be taken to clinic than older children (OR 2.7). Children judged as severely ill by their caretakers were taken to clinic significantly more often than those not thought to be severely ill (OR 1.7). Caretakers from households where the household head had a primary or secondary education were more likely to attend clinic than those were the household head reported no education (OR 1.5). Similarly, caretakers from households with moderate or high income attended clinic more frequently than did those with low income (56% vs. 49%, p = 0.15). 74% of clinic attenders reported they gave an antimalarial to the child with fever illness, compared to 42% of those who did not go to clinic (OR 4.0). Among caretakers who did not attend clinic, those from households were the head had a secondary education were more likely to give antimalarials (71%) than were those where the household head had a primary or no education (38%) (OR 4.0). Among those not attending clinic, most obtained medications at home (20%); street vendors or employers were reported as a source by only 2% of caretakers. Antipyretics were reported given to children by 62% of clinic attenders and 63% of those not attending clinics. Identification of optimal therapy and characteristics of caretakers linked with suboptimal therapy may help target specific groups to improve treatment of malaria fever episodes.
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