RESUMO
To provide early diagnosis and prompt treatment for malaria, two interventions were compared in refugee camps in Kalpitiya, Sri Lanka. Community health volunteers (HV's) were trained in diagnosis and management of malaria on clinical grounds, while a field laboratory was established in another group of camps providing treatment after laboratory confirmation of a malarial infection. Patients with fever sought treatment from HV's on average after 2.74 days and from the field laboratory after 3.20 days. Although acceptance of both interventions was high, the effective catchment areas, especially of the HV's were small. Large numbers of health volunteers would be needed to cover all families, making it difficult to sustain supervision and necessary logistic support. For every malaria patient treated by HV's, three others would receive anti-malarial drugs unnecessarily. The maintenance of a field laboratory with a microscopist of the Anti-Malaria Campaign is not an economically viable option. Training of HV's in microscopy with a mechanism for cost recovery should be given serious consideration. HV's and diagnosis and treatment centers should be able to handle a wide spectrum of common diseases. A better option for Sri Lanka in the short term might be to improve existing general health facilities that are accessible to the refugee population.
Assuntos
Adulto , Antimaláricos/administração & dosagem , Sangue/parasitologia , Criança , Cloroquina/administração & dosagem , Análise Custo-Benefício , Países em Desenvolvimento , Acessibilidade aos Serviços de Saúde/economia , Humanos , Malária Falciparum/diagnóstico , Malária Vivax/diagnóstico , Programas de Rastreamento/economia , Indigência Médica/economia , Microscopia , Equipe de Assistência ao Paciente/economia , Satisfação do Paciente , Primaquina/administração & dosagem , Refugiados , Programas Médicos Regionais , Sri Lanka , Voluntários/educaçãoRESUMO
The Thai economy has grown rapidly during the past three decades of modern industrialization. The structure of the economy has been changing from an agricultural to manufacturing based. Because industrial development policies has been biased toward Bangkok and surrounding provinces, regional income disparities have been widening. Despite the high growth record, Thailand has failed to distribute the benefits of economic growth equitably. This problem of income distribution could have many important consequences of relevance to the health of population.