Socio-cultural determinants of timely and delayed treatment of Buruli ulcer Implications for disease control 英文参考文献.docVIP

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Socio-cultural determinants of timely and delayed treatment of Buruli ulcer Implications for disease control 英文参考文献.doc

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Socio-cultural determinants of timely and delayed treatment of Buruli ulcer Implications for disease control 英文参考文献

Ackumeyetal.InfectiousDiseasesofpoverty2012,1:6 /content/1/1/6 RESEARCH ARTICLE OpenAccess Socio-culturaldeterminantsoftimelyanddelayed treatmentofBuruliulcer: implications for disease control MercyMAckumey1,2,3*,MargaretGyapong1,4,MatildaPappoe1,CynthiaKwakyeMaclean5andMitchellGWeiss2,3 Abstract Introduction:PublichealthprogrammesrecommendtimelymedicaltreatmentforBuruliulcer(BU)infectionto preventpre-ulcerconditionsfromprogressingtoulcers,tominimisesurgery,disabilitiesandthesocio-economic impactofBU.Clarifyingtheroleofsocio-culturaldeterminantsoftimelymedicaltreatmentmayassistinguiding publichealthprogrammestoimprovetreatmentoutcomes.Thisstudyclarifiedtheroleofsocio-cultural determinantsandhealthsystemfactorsaffectingtimelymedicaltreatmentforBUinanendemicareainGhana. Methods:Asemi-structuredexplanatorymodelinterviewbasedontheexplanatorymodelinterviewcatalogue (EMIC)wasadministeredto178BU-affectedpersons.Basedonresearchevidence,respondentswereclassifiedas timelytreatment(useofmedicaltreatment3monthsfromawarenessofdisease)anddelayedtreatment(medical treatment3monthsafteronsetofdiseaseandfailuretousemedicaltreatment).Theoutcomevariable,timely treatmentwasanalysedwithculturalepidemiologicalvariablesforcategoriesofdistress,perceivedcausesofBU, outside-helpandreasonsformedicaltreatmentinlogisticregressionmodels.Themediantimefortheonsetof symptomstotreatmentwascomputedindays.Qualitativephenomenologicalanalysisofrespondents’narratives clarifiedthemeaning,contextanddynamicfeaturesoftherelationshipofexplanatoryvariableswithtimelymedical treatment. Results:Themediantimeforinitiatingtreatmentwas25daysforpre-ulcers,and204daysforulcers.Incomeloss anduseofherbalistsshowedsignificantlynegativeassociationswithtimelytreatment.Respondents’useof herbalistswasoftenmotivatedbythedesireforquickrecoveryinordertocontinuewithworkandbecause herbalistswererelativesandeasilyaccessible.However,drinkinguncleanwaterwassignificantlyassociatedwith timelytreatmentandaccesstohealthservicesenco