Health Seeking Behaviour and Treatment Intentions of Dengue and Fever: A Household Survey of Children and Adults in Venezuela.
Health Seeking Behaviour and Treatment Intentions of Dengue and Fever: A Household Survey of Children and Adults in Venezuela.
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DOI：
10.1371/journal.pntd.0004237
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发表时间：
2015-12
影响因子：
3.8
通讯作者：
Tami A
中科院分区：
文献类型：
--
作者：
Elsinga J;Lizarazo EF;Vincenti MF;Schmidt M;Velasco-Salas ZI;Arias L;Bailey A;Tami A
委内瑞拉的登革热是一个主要的公共卫生问题，严重病例的发病率不断上升。早期诊断和及时治疗影响登革热疾病的结果，因为延误求医与导致严重登革热的并发症显著相关。我们的目的是了解登革热高发人群的求医行为模式，以改善早期到保健中心就诊的情况。2013年9月至2014年2月，在委内瑞拉马拉凯进行了一次横向住户调查。对成人和儿童父母/监护人的预期HSB进行了发烧或疑似登革热的评估。数据是通过对105个人的结构化问卷收集的。大多数人感觉有患登革热的风险，并认为它可能是一种致命的疾病。在登革热疑似病例中，大多数人(60%)会选择先寻求医疗帮助，而不是在家中接受第一次治疗，而在发烧的情况下，这一比例为11%。在那些决定去看医生的人中，疑似登革热感染会促使他们比只有发烧的人更早寻求医疗帮助(P<；0.001)。多因素分析模型显示，在登革热病例中，首次就诊意向与在家治疗意向相关的独立因素是感觉有风险(OR=3.29；P=0.042)和成年(而不是作为父母/监护人照顾孩子；OR=3.33，P=0.021)，有登革热感染史(OR=0.29，P=0.031)和居住在卡纳德阿祖卡(OR=0.28，P=0.038)附近与他们的第一次行动负相关。在美洲，对与登革热相关的HSB的了解很少，我们的研究试图有助于更好地了解该地区的HSB。提高对登革热疾病的早期认识和认识可提高受影响人群的及时就医情况，从而降低登革热的死亡率和严重程度。特别是对于那些以前感染过登革热的人，必须努力促进及时到卫生中心就诊。登革热在过去十年的快速传播使这一疾病在全球公共卫生议程中得到了更高的重视。登革热由白天叮咬的蚊子传播，通常表现为突然发烧和流感样症状。在一定比例的情况下，可能会接踵而至的严重疾病，如果不及时治疗，可能是致命的。在委内瑞拉，登革热流行和严重疾病的频率正在增加。寻求护理的延迟与严重疾病并发症的发展有关。在这项研究中，我们描述了人们在面临登革热感染时的健康相关行为意图，以找到促进及时就医的方法。在美洲，这类研究很少。我们发现，在单纯发烧的情况下，人们大多倾向于首先在家里治疗疾病，而在疑似登革热的情况下，他们会选择立即去看医生。这些意图令人鼓舞。然而，由于人们往往没有意识到自己感染了登革热，他们可能不会执行他们计划好的行为。此外，我们发现促使人们选择立即去看医生的几个因素：成年人(而不是作为父母/监护人照顾孩子)、居住地、感觉有风险以及以前没有登革热感染。因此，我们建议，提高对登革热症状和传播途径的风险认知和知识，可以提高及早到卫生中心就诊的机会，降低导致严重登革热和死亡的临床并发症的风险。
Dengue in Venezuela is a major public health problem with an increasing incidence of severe cases. Early diagnosis and timely treatment influences the outcome of dengue illness, as delay in care-seeking is significantly associated with complications leading to severe dengue. We aimed to understand patterns of health seeking behaviour (HSB) in individuals exposed to high dengue incidence in order to improve early attendance to health centres. Between September 2013 and February 2014 a cross-sectional household survey was performed in Maracay, Venezuela. Intended HSB of adults and children’s parents/guardians was assessed with respect to fever or suspected dengue. Data was collected through structured questionnaires from 105 individuals. Most individuals felt at risk of dengue and believed it could be a deadly disease. In the case of suspected dengue, the majority (60%) would choose to first seek medical help versus first treating at home, in contrast to 11% in the case of fever. Amongst those who decided to visit a doctor, a suspected dengue infection would prompt them to search medical help earlier than if having only fever (p<0.001). Multivariate analysis modelling showed that the independent factors associated with the intention to firstly visit a doctor versus treating at home in the case of dengue were feeling at risk (OR = 3.29; p = 0.042) and being an adult (as opposed to caring for a child as a parent/guardian; OR = 3.33, p = 0.021), while having had a previous dengue infection (OR = 0.29; p = 0.031) and living in the neighbourhood Caña de Azúcar (OR = 0.28, p = 0.038) were negatively associated with seeking medical care as their first action. Knowledge of HSB related to dengue is scarce in the Americas, our study attempts to contribute to a better understanding of HSB in this region. Improving early dengue disease recognition and awareness may enhance prompt attendance to medical care in affected populations and thereby reduce mortality and severity of dengue. Especially for those with a previous dengue infection, efforts have to be made to promote prompt health centre attendance. The rapid spread of dengue in the last decade has brought this disease higher in the public health agenda worldwide. Dengue is transmitted by day-biting mosquitoes and typically presents with sudden fever and flu-like symptoms. In a proportion of cases, severe disease can ensue which if not promptly treated can be lethal. In Venezuela, the frequency of dengue epidemics and severe disease is on the increase. Delay in care-seeking has been related to the development of serious disease complications. In this study, we describe the health-related behaviour intentions people have when they face a dengue infection, to find ways to promote prompt medical care attendance. Few studies of this kind exist in the Americas. We found that in case of fever alone, people would mostly prefer to first treat the disease at home while in the case of suspected dengue they would choose to promptly visit a doctor. These intentions are encouraging. However, since people often do not realize they have dengue, they may not perform their planned behaviour. Moreover, we found several factors that made people choose to visit promptly a doctor: being an adult (as opposed to caring for a child as a parent/guardian), place of residence, feeling at risk and not having had a previous dengue infection. Therefore, we suggest that raising risk perception and the knowledge on dengue symptoms and transmission route could improve earlier health centre attendance lowering the risk of clinical complications leading to severe dengue and death.