Satisfaction about Patient-centeredness and Healthcare System among Patients with Chronic Multimorbidity

The aim of the present study was to measure the prevalence of multimorbidity in Bangladesh,India and China,and to assess the relationship between multimorbidity and patient's opinion regarding their involvement in healthcare decision-making and overall satisfaction of healthcare system.Cross-sectional data on 18696 men and women aged 18 and above were collected from the World Health Survey of World Health Organization(WHO).Outcome variables were subjective rating of(1)healthcare system's ability to involve patients in decision-making,and(2)satisfaction with the way healthcare system runs in the country.Self-reported chronic conditions were used to measure the prevalence of multimorbidity.Out of 9 chronic conditions,back pain,arthritis,and chronic cough appeared to be the most prevalent ones among majority of the participants.About one-third of the participants in China(30.7%)and two-thirds in Bangladesh(66.1%)and India(66.6%)reported having at least one chronic illness.Prevalence of multimorbidity was highest in India(34.3%)followed by Bangladesh(28.8%)and China(14.3%).In Bangladesh,India and China,respectively 70.5%,41.7%,61.3%women and 54.5%,42.8%and 58.8%men expressed dissatisfaction regarding the way healthcare system runs in their country.In Bangladesh and India,men who were living with multimorbidity were more likely to rate the patient-centeredness as"bad"than those who had no disease illness.This study suggests that the prevalence of multimorbidity was remarkably high especially in Bangladesh and India.Higher likelihood of dissatisfaction about healthcare system among multimorbid patients might be indicative of inadequacy in the provision of care in qualitative and quantitative terms.

Shrinking the malaria map in China: measuring the progress of the National Malaria Elimination Programme

Background:Remarkable progress has been made towards the elimination of malaria in China since the National Malaria Elimination Programme(NMEP)was launched in 2010.The incidence of locally-acquired malaria cases has declined rapidly and endemic areas have also dramatically shrunk.In total,3078 malaria cases were reported in 2014,but only 56 cases were indigenous.In order to further promote the elimination programme,we reviewed the progress of and experiences associated with malaria elimination in China,and identified the challenges and priorities for the next stage of the programme.Methods:Data were collected from the web-based China Information System for Disease Control and Prevention,and the China Annual Report of Malaria Elimination.The progress towards the elimination of malaria from 2010 to 2014 was measured.Results:During the implementation of the NMEP from 2010 to 2014,local malaria incidence has declined continuously,only remaining in the Yunnan Province and Tibet Autonomous Region in 2014.By the end of 2015,75.6%(1636/2163)of the malaria-endemic counties passed the sub-national elimination assessment.The main challenges are cases of border malaria and imported malaria from other countries.Sustainable support and investment from the government,the establishment of an effective surveillance and response system,and risk assessments for the potential reintroduction of malaria are priorities for the next stage of the elimination programme.Conclusions:The NMEP in China has been successfully implemented thus far and the malaria map has shrunk dramatically.The priorities for malaria elimination are interventions to block transmission at border areas,management of imported malaria cases,preventing malaria reintroduction,capacity building,and sustainability of malaria surveillance and response.

Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria

Background:The spleen plays a pivotal role in the rapid clearance of parasitized red blood cells in patients with falciparum malaria after artemisinin treatment.Prolonged parasite clearance can be found in patients who have had a splenectomy,or those with hemoglobin abnormalities and/or reduced immunity,which are all distinguishable from artemisinin resistance.This paper reports on a case of prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria.Case presentation:A 35-year-old Chinese male suffered 2 days of febrile illness after returning to Zhumadian city of Henan province from Nigeria on October 1,2014.The main symptoms were febrile,including the highest axillary temperature of 40℃,headache,and chills.A peripheral blood smear showed parasitemia(53913 asexual parasites/μl)of Plasmodium falciparum.The patient had not used any chemoprophylaxis against malaria in Nigeria when he worked there as a construction worker between 2009 and 2014.The patient had three episodes of malaria in Nigeria and had a splenectomy due to a traffic accident 8 years ago from the time he was admitted to hospital.The patient was orally administrated a total of 320 mg/2.56 g dihydroartemisinin-piperaquine for 2 days and intravenously administrated a total of 3000 mg artesunate for 18 days.The axillary temperature of the patient ranged between 37.0 and 37.7℃ from Day 0 to Day 3,and blood microscopy revealed falciparum malaria parasitemia(26674 asexual parasites/μl)on Day 3.The patient was afebrile on Day 4,falciparum malaria parasitemia was continuously present and then gradually decreased on the next days,and was negative on Day 21.The patient was cured and left hospital on Day 24 after no plasmodium falciparum was found in the blood on Day 21 to Day 23.No mutation was found in the K13 propeller gene when compared with the PF3D7_1343700 K13 propeller gene reference sequence.Conclusions:This is the first reported case in China of prolonged parasite clearance in a splenectomized patient with imported falciparum malaria.Artemisinin resistance should be distinguished when prolonged parasite clearance is found in a malaria patient who has had splenectomy.