Access to health care in relation to socioeconomic status in the Amazonian area of Peru
Access to health care in relation to socioeconomic status in the Amazonian area of Peru
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DOI：
10.1186/1475-9276-8-11
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发表时间：
2009-04-15
影响因子：
4.8
通讯作者：
Hartvig, Per
中科院分区：
文献类型：
--
作者：
Kristiansson, Charlotte;Gotuzzo, Eduardo;Hartvig, Per
背景资料：在许多低收入和中等收入国家，获得负担得起的保健服务的机会有限，保健系统往往不公平，向最需要的穷人提供的保健服务较少。本研究的目的是调查寻求健康的行为和利用药物的家庭社会经济地位的儿童在两个小的亚马逊城市社区的秘鲁;尤里马瓜斯，洛雷托和Moyobamba部，圣马丁，秘鲁。方法：横断面研究设计包括家庭访谈。尤里马瓜斯的780名6-72个月儿童和莫约班巴的793名同龄儿童的照顾者被纳入研究。照顾者进行了采访的医疗保健寻求战略（公共/私营部门，正式/非正式的供应商），并为他们的孩子报告的症状和社会经济地位的药物。根据IMCI算法（儿童疾病综合管理），将自我报告的症状分类为疾病。财富被用作经济地位的替代指标。财富值产生的主成分分析，使用家庭资产和characteristics.Results：显着更多的照顾者从最贫困阶层咨询卫生专业人员咳嗽/感冒（p < 0.05：OR = 4.30）比最贫困阶层。最贫穷阶层使用抗生素治疗咳嗽/感冒和咳嗽/感冒+腹泻的比例（分别为16%、38%）低于最不贫穷阶层（分别为31%、52%）。对于肺炎和/或痢疾，最贫穷的人使用的抗生素显着减少（16%）比最不穷（80%）。结论：最贫穷的人寻求较少的照顾，从卫生专业人员的非严重疾病以及严重的疾病;和抗生素治疗缺乏疾病的地方，它会表明。照顾者经常支付医疗服务和抗生素，尽管研究中的所有儿童都有资格获得免费医疗和药物。必须改进综合健康保险的执行情况。
Background: Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drugs in relation to household socioeconomic status for children in two small Amazonian urban communities of Peru; Yurimaguas, Department of Loreto and Moyobamba, Department of San Martin, Peru.Methods: Cross-sectional study design included household interviews. Caregivers of 780 children aged 6-72 months in Yurimaguas and 793 children of the same age in Moyobamba were included in the study. Caregivers were interviewed on health care seeking strategies (public/private sectors; formal/informal providers), and medication for their children in relation to reported symptoms and socio-economic status. Self-reported symptoms were classified into illnesses based on the IMCI algorithm (Integrated Management of Childhood Ilness). Wealth was used as a proxy indicator for the economic status. Wealth values were generated by Principal Component Analysis using household assets and characteristics.Results: Significantly more caregivers from the least poor stratum consulted health professionals for cough/cold (p < 0.05: OR = 4.30) than the poorest stratum. The poorest stratum used fewer antibiotics for cough/cold and for cough/cold + diarrhoea (16%, 38%, respectively) than the least poor stratum (31%, 52%, respectively). For pneumonia and/or dysentery, the poorest used significantly fewer antibiotics (16%) than the least poor (80%).Conclusion: The poorest seek less care from health professionals for non-severe illnesses as well as for severe illnesses; and treatment with antibiotics is lacking for illnesses where it would be indicated. Caregivers frequently paid for health services as well as antibiotics, even though all children in the study qualified for free health care and medicines. The implementation of the Seguro Integral de Salud health insurance must be improved.