Discovering the cost of care: consumer, provider, and retailer surveys shed light on the determinants of malaria health-seeking behaviours
Discovering the cost of care: consumer, provider, and retailer surveys shed light on the determinants of malaria health-seeking behaviours
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DOI：
10.1186/s12936-016-1232-7
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发表时间：
2016-03-22
期刊：
影响因子：
3
通讯作者：
Yan, Guiyun
中科院分区：
文献类型：
--
作者：
Dixit, Amruta;Lee, Ming-Chieh;Yan, Guiyun
背景资料：蚊子对杀虫剂的抗药性和疟原虫对药物的抗药性的威胁越来越大，因此，确保适当的疟疾病例管理和促进积极的求医行为更加重要。在疟疾流行地区，寻求治疗的行为特征不明显，而这些地区一直是密集控制和消灭疟疾运动的重点。本研究采用了一种全面的方法来阐明疟疾寻求治疗的行为从不同的perspectives.Methods的决定因素：作者进行了横断面调查，从832个家庭，15个卫生中心，135个零售商在三个地点的Emuhaya和卡卡梅加地区的肯尼亚西部高地。通过随机抽样招募参与者，并使用关于疟疾寻求治疗行为的结构化问卷收集数据。所有的家庭，医疗机构和零售商使用手持GPS和GIS算法被用来计算“步行距离”的基础上的Tobler规则，这个距离的估计被用来计算在分析中使用的旅行时间。结果：在三个站点，47.5- 78.9%的居民寻求诊断和治疗的医院，诊所，或药房; 6.3- 26.1%的居民仅在药品零售商处寻求疟疾治疗。总体而言，40.3- 59.4%的居民报告在发热后延迟就医超过24小时。调整后，选择去药品零售机构而不是医院的居民在发烧后推迟就医的可能性比选择医疗机构治疗的居民高121和307%。旅行时间和延迟就医之间没有显着的关联。对保健设施的调查表明，每位病人每次就诊的平均总费用为112肯尼亚先令。（1.40美元）用于公共设施和165 KES（2.06美元）的私人设施。了解使疟疾传播永久化的当地健康行为将有助于制定有针对性的预防措施和教育干预措施，使居民掌握防治疟疾所需的知识。以安全有效的方式防治疟疾。在疾病负担高的国家，确保病人能够利用保健设施对公平措施和公共卫生预防方法具有更广泛的影响。
Background: The growing threat of insecticide resistance in mosquitoes and drug resistance in the Plasmodium parasites increases the importance of ensuring appropriate malaria case management and enabling positive health-seeking behaviour. Treatment-seeking behaviours are poorly characterized in malaria-endemic regions that have been the focus of intensive control and elimination campaigns. This study uses a comprehensive approach to shed light on the determinants of malaria treatment-seeking behaviours from different perspectives.Methods: The authors conducted cross-sectional surveys from 832 households, fifteen health centers, and 135 retailers across three sites in the Emuhaya and Kakamega districts of the western Kenyan highlands. Participants were recruited via random sampling and data were collected with the use of a structured questionnaire about malaria treatment-seeking behaviour. All households, healthcare facilities, and retailers were mapped using a handheld GPS and a GIS algorithm was used to calculate "walk distance" based on the Tobler rule; an estimate of this distance was used to calculate the travel time used in the analyses.Results: Across the three sites, 47.5-78.9 % of the residents sought diagnosis and treatment at hospitals, clinics, or dispensaries; 6.3-26.1 % of the residents sought malaria care only at pharmaceutical retailers. Overall, 40.3-59.4 % of residents reported delaying seeking care for more than 24 h after fever onset. After adjustment, residents who chose to visit a pharmaceutical retail facility rather than a hospital were 121 and 307 % more likely to delay seeking medical care after fever onset than those who reported choosing a healthcare facility for treatment. No significant association was found between travel time and delay in seeking care. The surveys of the healthcare facilities indicated an average total cost per patient per visit was 112 KES ($1.40 US) for public facilities and 165 KES ($2.06 US) for private facilities.Conclusion: Understanding the local health behaviours that perpetuate transmission of malaria will help develop targeted preventive measures and educational interventions that can empower the residents with the knowledge needed to combat malaria in a safe and effective manner. Ensuring patient access to health care facilities in countries with high disease burdens has broader implications on measures of equity and on public health prevention methodologies.