Exploring different health care providers´ perceptions on the management of diarrhoea in cholera hotspots in the Democratic Republic of Congo: A qualitative content analysis.

Autor:	Schedwin M; Department of Global Public Health, Stockholm, Sweden.; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden., Furaha AB; Paediatric Department, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo., Hildenwall H; Department of Global Public Health, Stockholm, Sweden.; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Science, Karolinska Institutet, Intervention and Technology, Stockholm, Sweden., Elimian K; Department of Global Public Health, Stockholm, Sweden.; Exhale Health Foundation, Abuja, Nigeria., Malembaka EB; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.; Center for Tropical Diseases and Global Health, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo., Yambayamba MK; Vetsuisse Faculty, Section Epidemiology, University of Zurich, Zurich, Switzerland.; Department of Epidemiology and Biostatistics, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo., Forsberg BC; Department of Global Public Health, Stockholm, Sweden., Van Damme W; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium., Alfvén T; Department of Global Public Health, Stockholm, Sweden.; Sach's Children and Youth Hospital, Stockholm, Sweden., Carter SE; Public Health Emergencies, UNICEF, Kinshasa, Democratic Republic of Congo., Okitayemba PW; Programme National d'Elimination du Choléra et de Lutte Contre les Autres Maladies Diarrhéiques, Kinshasa, Democratic Republic of Congo., Mapatano MA; Department of Nutrition, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo., King C; Department of Global Public Health, Stockholm, Sweden.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2024 Mar 19; Vol. 4 (3), pp. e0002896. Date of Electronic Publication: 2024 Mar 19 (Print Publication: 2024).
DOI:	10.1371/journal.pgph.0002896
Abstrakt:	Global cholera guidelines support wider healthcare system strengthening interventions, alongside vertical outbreak responses, to end cholera. Well-trained healthcare providers are essential for a resilient health system and can create synergies with childhood diarrhoea, which has higher mortality. We explored how the main provider groups for diarrhoea in cholera hotspots interact, decide on treatment, and reflect on possible limiting factors and opportunities to improve prevention and treatment. We conducted focus group discussions in September 2022 with different healthcare provider types in two urban and two rural cholera hotspots in the North Kivu and Tanganyika provinces in the Eastern Democratic Republic of Congo. Content analysis was used with the same coding applied to all providers. In total 15 focus group discussions with medical doctors (n = 3), nurses (n = 4), drug shop vendors (n = 4), and traditional health practitioners (n = 4) were performed. Four categories were derived from the analysis. (i) Provider dynamics: scepticism between all cadres was prominent, whilst also acknowledging the important role all provider groups have in current case management. (ii) Choice of treatment: affordability and strong caregiver demands shaped by cultural beliefs strongly affected choice. (iii) Financial consideration on access: empathy was strong, with providers finding innovative ways to create access to treatment. Concurrently, financial incentives were important, and providers asked for this to be considered when subsiding treatment. (iv) How to improve: the current cholera outbreak response approach was appreciated however there was a strong wish for broader long-term interventions targeting root causes, particularly community access to potable water. Drug shops and traditional health practitioners should be considered for inclusion in health policies for cholera and other diarrhoeal diseases. Financial incentives for the provider to improve access to low-cost treatment and investment in access to potable water should furthermore be considered. Competing Interests: I have read the journal’s policy, and the authors of this manuscript have the following competing interests: Placide Welo Okitayemba is leading the Programme National d’Elimination du Choléra (National Cholera Program) et de lutte contre les autres Maladies Diarrhéiques residing within the Ministry of Health in the Democratic Republic of Congo. Simon E Carter is leading the work of UNICEF Integrated Analytics Cell, which is actively involved in the DRC cholera response. No other author declares competing interests. (Copyright: © 2024 Schedwin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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