Utilization of public or private health care providers by febrile children after user fee removal in Uganda
Utilization of public or private health care providers by febrile children after user fee removal in Uganda
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DOI：
10.1186/1475-2875-8-45
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发表时间：
2009-03-14
期刊：
影响因子：
3
通讯作者：
Kallander, Karin
中科院分区：
文献类型：
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作者：
Rutebemberwa, Elizeus;Pariyo, George;Kallander, Karin
背景：尽管乌干达政府投资提供免费医疗服务，但许多看护者仍在药店/私人诊所寻求治疗。该研究旨在评估五岁以下儿童使用政府设施或药店/私人诊所治疗发热性疾病的决定因素。方法：对伊甘加-马尤格人口监测点随机选择的 1078 个家庭的看护者进行结构化调查问卷。那些在过去两周内发烧并在户外寻求护理的孩子接受了采访，了解他们出现的症状以及他们选择就诊的原因。将儿童出现的症状和到政府机构就诊的原因与去药店/私人诊所就诊的情况进行比较。结果：在外出就医的儿童中，62.7%（286/456）首先去药店/私人诊所，33.1%（151/456）首先去政府机构。带着发热儿童前往政府机构的预测因素是儿童出现呕吐（OR 2.07；95% CI 1.10-3.89）并认为医疗服务提供者合格（OR 10.32；95% CI 5.84-18.26）或经验丰富（OR 1.93；95% CI 1.07-3.48）。那些带发烧儿童去药店/私人诊所的人这样做是因为他们要去那里寻求急救（OR 0.20；95% CI 0.08-0.52）。结论：私人医疗服务提供者为发烧儿童的看护者提供“急救”。政府对医疗保健提供者的财政援助不应仅限于政府设施。私营部门的多方面干预以及通过社区药品经销商对发热儿童实施社区病例管理可以提高及时获得优质护理的儿童比例。
Background: Despite investments in providing free government health services in Uganda, many caretakers still seek treatment from the drug shops/private clinics. The study aimed to assess determinants for use of government facilities or drug shops/private clinics for febrile illnesses in children under five.Methods: Structured questionnaires were administered to caretakers in 1078 randomly selected households in the Iganga-Mayuge Demographic Surveillance site. Those with children who had had fever in the previous two weeks and who had sought care from outside the home were interviewed on presenting symptoms and why they chose the provider they went to. Symptoms children presented with and reasons for seeking care from government facilities were compared with those of drug shops/private clinics.Results: Of those who sought care outside the home, 62.7% (286/456) had first gone to drug shops/private clinics and 33.1% (151/456) first went to government facilities. Predictors of having gone to government facilities with a febrile child were child presenting with vomiting (OR 2.07; 95% CI 1.10-3.89) and perceiving that the health providers were qualified (OR 10.32; 95% CI 5.84-18.26) or experienced (OR 1.93; 95% CI 1.07-3.48). Those who took the febrile child to drug shops/private clinics did so because they were going there to get first aid (OR 0.20; 95% CI 0.08-0.52).Conclusion: Private providers offer 'first aid' to caretakers with febrile children. Government financial assistance to health care providers should not stop at government facilities. Multi-faceted interventions in the private sector and implementation of community case management of febrile children through community medicine distributors could increase the proportion of children who access quality care promptly.