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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Randomised primary health center based interventions to improve the diagnosis and treatment of undifferentiated fever and dengue in Vietnam
BMC Health Services Research, Volume 10, Article 275, Year 2010
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Description
Background. Fever is a common reason for attending primary health facilities in Vietnam. Response of health care providers to patients with fever commonly consists of making a presumptive diagnosis and proposing corresponding treatment. In Vietnam, where malaria was brought under control, viral infections, notably dengue, are the main causes of undifferentiated fever but they are often misdiagnosed and inappropriately treated with antibiotics. This study investigate if educating primary health center (PHC) staff or introducing rapid diagnostic tests (RDTs) improve diagnostic resolution and accuracy for acute undifferentiated fever (AUF) and reduce prescription of antibiotics and costs for patients. Methods. In a PHC randomized intervention study in southern Vietnam, the presumptive diagnoses for AUF patients were recorded and confirmed by serology on paired (acute and convalescence) sera. After one year, PHCs were randomized to four intervention arms: training on infectious diseases (A), the provision of RDTs (B), the combination (AB) and control (C). The intervention lasted from 2002 until 2006. Results. The frequency of the non-etiologic diagnosis "undifferentiated fever" decreased in group AB, and - with some delay- also in group B. The diagnosis "dengue" increased in group AB, but only temporarily, although dengue was the most common cause of fever. A correct diagnosis for dengue initially increased in groups AB and B but only for AB this was sustained. Antibiotics prescriptions increased in group C. During intervention it initially declined in AB with a tendency to increase afterwards; in B it gradually declined. There was a substantial increase of patients' costs in B. Conclusions. The introduction of RDTs for infectious diseases such as dengue, through free market principles, does improve the quality of the diagnosis and decreases the prescription of antibiotics at the PHC level. However, the effect is more sustainable in combination with training; without it RDTs lead to an excess of costs. © 2010 Phuong et al; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC2955016/bin/1472-6963-10-275-S1.DOC
Authors & Co-Authors
Phuöng, Hoanglan
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Viet Nam, Ho Chi Minh City
Cho Ray Hospital
Nga, Tran Vu Thieu
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Viet Nam, Ho Chi Minh City
Cho Ray Hospital
Giao, Phan Trong
Viet Nam, Ho Chi Minh City
Cho Ray Hospital
Hung, Lequoc
Viet Nam, Ho Chi Minh City
Cho Ray Hospital
Binh, Tran Quang
Viet Nam, Ho Chi Minh City
Cho Ray Hospital
van Nam, Nguyenvan
Viet Nam
Binh Thuan Medical College
Nagelkerke, Nico J.D.
United Arab Emirates, Al Ain
United Arab Emirates University
de Vries, Peter J.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Statistics
Citations: 12
Authors: 8
Affiliations: 4
Identifiers
Doi:
10.1186/1472-6963-10-275
e-ISSN:
14726963
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Randomised Control Trial