Health-seeking patterns among participants of population-based morbidity surveillance in rural western Kenya: implications for calculating disease rates
Health-seeking patterns among participants of population-based morbidity surveillance in rural western Kenya: implications for calculating disease rates
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DOI：
10.1016/j.ijid.2010.05.016
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发表时间：
2010-11-01
影响因子：
8.4
通讯作者：
Feikin, Daniel R.
中科院分区：
文献类型：
--
作者：
Bigogo, Godfrey;Audi, Allan;Feikin, Daniel R.
背景：发展中国家使用基于设施的监测计算疾病发生率受到卫生利用模式的影响。我们描述了按症状寻求医疗保健的时间模式，作为肯尼亚西部农村地区基于人口的发病率监测的一部分。方法：从 2006 年 7 月到 2008 年 6 月，通过每两周一次的家访和 Lwak 医院（指定的转诊诊所，专门的研究临床工作人员提供免费护理）收集了 27 171 名参与者的健康利用数据。病人被询问是否以及在哪里寻求治疗。通过卡方检验比较因发烧、急性呼吸道感染 (ARI)、急性下呼吸道感染 (ALRI) 和腹泻而寻求护理的儿童和成人的比例。通过逻辑回归评估按距离寻求护理的情况。结果：虽然所有综合征都在家庭外寻求护理（>50%），但只有 18-38% 的护理是到医疗机构寻求护理。儿童比成人更有可能因所有综合症而去医疗机构就诊。在 Lwak 医院就诊的病人中，45-54% 的人此前曾在其他地方寻求治疗，其中大部分来自非正规药品销售商，11-24% 的发烧、ARI 或 ALRI 患者已经服用过抗疟药或抗生素。参与者的家距离 Lwak 医院较远是患病参与者不前往 Lwak 医院寻求治疗的最常见原因 (71%)。访问 Lwak 的可能性随着居住距离的增加而降低 (p < 0.001)，并且在研究期间波动显着。结论：即使在提供免费和可靠护理的研究环境中，健康利用率也会受到其他因素（例如距离）的影响。基于人群的监测中的健康利用数据对于调整疾病发生率非常重要。 (C) 2010 年国际传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Background: Calculation of disease rates in developing countries using facility-based surveillance is affected by patterns of health utilization. We describe temporal patterns in health care seeking by syndrome as part of population-based morbidity surveillance in rural western Kenya.Methods: From July 2006 to June 2008, health utilization data were collected from 27 171 participants at biweekly home visits and at Lwak Hospital, the designated referral clinic where free care provided by dedicated study clinical staff was available. Ill persons were asked if and where they sought care. Proportions seeking care for children and adults with fever, acute respiratory infection (ARI), acute lower respiratory infection (ALRI), and diarrhea were compared by Chi-square test. Care-seeking by distance was evaluated by logistic regression.Results: While care-seeking outside the home was common for all syndromes (>50%), only 18-38% of care-seeking was to health facilities. Children were more likely than adults to visit health facilities for all syndromes. Of ill persons visiting Lwak Hospital, 45-54% had previously sought care elsewhere, mostly from informal drug sellers, and 11-24% with fever, ARI, or ALRI had already taken an antimalarial or antibiotic. The distance from the participant's home to Lwak Hospital was the most common reason (71%) for ill participants not seeking care there. The likelihood of visiting Lwak decreased with increasing distance of residence (p < 0.001) and fluctuated significantly over the study period.Conclusions: Even in a study setting where free and reliable care is offered, health utilization is affected by other factors, such as distance. Health utilization data in population-based surveillance are important in adjusting disease rates. (C) 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.