Health Seeking Behaviour and Utilization of Health Facilities for Schistosomiasis-Related Symptoms in Ghana
Identifieur interne : 000423 ( Pmc/Checkpoint ); précédent : 000422; suivant : 000424Health Seeking Behaviour and Utilization of Health Facilities for Schistosomiasis-Related Symptoms in Ghana
Auteurs : Anthony Danso-Appiah [Pays-Bas, Royaume-Uni] ; Wilma A. Stolk [Pays-Bas] ; Kwabena M. Bosompem [Ghana] ; Joseph Otchere [Ghana] ; Caspar W. N. Looman [Pays-Bas] ; J. Dik F. Habbema [Pays-Bas] ; Sake J. De Vlas [Pays-Bas]Source :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2010.
Abstract
Schistosomiasis causes long-term illness and significant economic burden. Morbidity control through integration within existing health care delivery systems is considered a potentially sustainable and cost-effective approach, but there is paucity of information about health-seeking behaviour.
A questionnaire-based study involving 2,002 subjects was conducted in three regions of Ghana to investigate health-seeking behaviour and utilization of health facilities for symptoms related to urinary (blood in urine and painful urination) and intestinal schistosomiasis (diarrhea, blood in stool, swollen abdomen and abdominal pain). Fever (for malaria) was included for comparison.
Only 40% of patients with urinary symptoms sought care compared to >70% with intestinal symptoms and >90% with fever. Overall, about 20% of schistosomiasis-related symptoms were reported to a health facility (hospital or clinic), compared to about 30% for fever. Allopathic self-medication was commonly practiced as alternative action. Health-care seeking was relatively lower for patients with chronic symptoms, but if they took action, they were more likely to visit a health facility. In a multivariate logistic regression analysis, perceived severity was the main predictor for seeking health care or visiting a health facility. Age, socio-economic status, somebody else paying for health care, and time for hospital visit occasionally showed a significant impact, but no clear trend. The effect of geographic location was less marked, although people in the central region, and to a lesser extent the north, were usually less inclined to seek health care than people in the south. Perceived quality of health facility did not demonstrate impact.
Perceived severity of the disease is the most important determinant of seeking health care or visiting a health facility in Ghana. Schistosomiasis control by passive case-finding within the regular health care delivery looks promising, but the number not visiting a health facility is large and calls for supplementary control options.
Url:
DOI: 10.1371/journal.pntd.0000867
PubMed: 21072229
PubMed Central: 2970540
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Stolk</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam</wicri:regionArea><placeName><settlement type="city">Rotterdam</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Bosompem, Kwabena M" sort="Bosompem, Kwabena M" uniqKey="Bosompem K" first="Kwabena M." last="Bosompem">Kwabena M. Bosompem</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Parasitology Department, Noguchi Memorial Institute for Medical Research, Legon, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Parasitology Department, Noguchi Memorial Institute for Medical Research, Legon</wicri:regionArea><wicri:noRegion>Legon</wicri:noRegion></affiliation></author><author><name sortKey="Otchere, Joseph" sort="Otchere, Joseph" uniqKey="Otchere J" first="Joseph" last="Otchere">Joseph Otchere</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Parasitology Department, Noguchi Memorial Institute for Medical Research, Legon, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Parasitology Department, Noguchi Memorial Institute for Medical Research, Legon</wicri:regionArea><wicri:noRegion>Legon</wicri:noRegion></affiliation></author><author><name sortKey="Looman, Caspar W N" sort="Looman, Caspar W N" uniqKey="Looman C" first="Caspar W. N." last="Looman">Caspar W. N. Looman</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam</wicri:regionArea><placeName><settlement type="city">Rotterdam</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Habbema, J Dik F" sort="Habbema, J Dik F" uniqKey="Habbema J" first="J. Dik F." last="Habbema">J. Dik F. Habbema</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam</wicri:regionArea><placeName><settlement type="city">Rotterdam</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="De Vlas, Sake J" sort="De Vlas, Sake J" uniqKey="De Vlas S" first="Sake J." last="De Vlas">Sake J. De Vlas</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam</wicri:regionArea><placeName><settlement type="city">Rotterdam</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author></analytic><series><title level="j">PLoS Neglected Tropical Diseases</title><idno type="ISSN">1935-2727</idno><idno type="eISSN">1935-2735</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Schistosomiasis causes long-term illness and significant economic burden. Morbidity control through integration within existing health care delivery systems is considered a potentially sustainable and cost-effective approach, but there is paucity of information about health-seeking behaviour.</p></sec><sec><title>Methods</title><p>A questionnaire-based study involving 2,002 subjects was conducted in three regions of Ghana to investigate health-seeking behaviour and utilization of health facilities for symptoms related to urinary (blood in urine and painful urination) and intestinal schistosomiasis (diarrhea, blood in stool, swollen abdomen and abdominal pain). Fever (for malaria) was included for comparison.</p></sec><sec><title>Results</title><p>Only 40% of patients with urinary symptoms sought care compared to >70% with intestinal symptoms and >90% with fever. Overall, about 20% of schistosomiasis-related symptoms were reported to a health facility (hospital or clinic), compared to about 30% for fever. Allopathic self-medication was commonly practiced as alternative action. Health-care seeking was relatively lower for patients with chronic symptoms, but if they took action, they were more likely to visit a health facility. In a multivariate logistic regression analysis, perceived severity was the main predictor for seeking health care or visiting a health facility. Age, socio-economic status, somebody else paying for health care, and time for hospital visit occasionally showed a significant impact, but no clear trend. The effect of geographic location was less marked, although people in the central region, and to a lesser extent the north, were usually less inclined to seek health care than people in the south. Perceived quality of health facility did not demonstrate impact.</p></sec><sec><title>Conclusion</title><p>Perceived severity of the disease is the most important determinant of seeking health care or visiting a health facility in Ghana. Schistosomiasis control by passive case-finding within the regular health care delivery looks promising, but the number not visiting a health facility is large and calls for supplementary control options.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Engels, D" uniqKey="Engels D">D Engels</name></author><author><name sortKey="Savioli, L" uniqKey="Savioli L">L Savioli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hotez, Pj" uniqKey="Hotez P">PJ Hotez</name></author><author><name sortKey="Molyneux, Dh" uniqKey="Molyneux D">DH Molyneux</name></author><author><name sortKey="Fenwick, A" uniqKey="Fenwick A">A Fenwick</name></author><author><name sortKey="Ottesen, E" uniqKey="Ottesen E">E Ottesen</name></author><author><name sortKey="Ehrlich Sachs, S" uniqKey="Ehrlich Sachs S">S Ehrlich Sachs</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Steinmann, P" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosntds</journal-id><journal-title-group><journal-title>PLoS Neglected Tropical Diseases</journal-title></journal-title-group><issn pub-type="ppub">1935-2727</issn><issn pub-type="epub">1935-2735</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21072229</article-id><article-id pub-id-type="pmc">2970540</article-id><article-id pub-id-type="publisher-id">09-PNTD-RA-0356R3</article-id><article-id pub-id-type="doi">10.1371/journal.pntd.0000867</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline"><subject>Infectious Diseases/Helminth Infections</subject><subject>Infectious Diseases/Neglected Tropical Diseases</subject><subject>Infectious Diseases/Tropical and Travel-Associated Diseases</subject><subject>Public Health and Epidemiology</subject><subject>Public Health and Epidemiology/Environmental Health</subject><subject>Public Health and Epidemiology/Epidemiology</subject><subject>Public Health and Epidemiology/Global Health</subject><subject>Public Health and Epidemiology/Health Policy</subject><subject>Public Health and Epidemiology/Health Services Research and Economics</subject><subject>Public Health and Epidemiology/Preventive Medicine</subject><subject>Public Health and Epidemiology/Social and Behavioral Determinants of Health</subject><subject>Science Policy/Education</subject></subj-group></article-categories><title-group><article-title>Health Seeking Behaviour and Utilization of Health Facilities for Schistosomiasis-Related Symptoms in Ghana</article-title><alt-title alt-title-type="running-head">Integrated Schistosomiasis Control</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Danso-Appiah</surname><given-names>Anthony</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Stolk</surname><given-names>Wilma A.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bosompem</surname><given-names>Kwabena M.</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Otchere</surname><given-names>Joseph</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Looman</surname><given-names>Caspar W. N.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Habbema</surname><given-names>J. Dik F.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>de Vlas</surname><given-names>Sake J.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Centre for Reviews and Dissemination, University of York, York, United Kingdom</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Parasitology Department, Noguchi Memorial Institute for Medical Research, Legon, Ghana</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Raso</surname><given-names>Giovanna</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1">Centre Suisse de Recherches Scientifiques, Côte d'Ivoire</aff><author-notes><corresp id="cor1">* E-mail: <email>ada505@york.ac.uk</email></corresp><fn fn-type="con"><p>Conceived and designed the experiments: ADA KMB JDFH SJdV. Performed the experiments: ADA KMB JO. Analyzed the data: ADA WAS CWNL JDFH SJdV. Contributed reagents/materials/analysis tools: ADA WAS CWNL JDFH SJdV. Wrote the paper: ADA WAS KMB JO CWNL JDFH SJdV.</p></fn></author-notes><pub-date pub-type="collection"><month>11</month><year>2010</year></pub-date><pub-date pub-type="epub"><day>2</day><month>11</month><year>2010</year></pub-date><volume>4</volume><issue>11</issue><elocation-id>e867</elocation-id><history><date date-type="received"><day>13</day><month>8</month><year>2009</year></date><date date-type="accepted"><day>1</day><month>10</month><year>2010</year></date></history><permissions><copyright-statement>Danso-Appiah et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</copyright-statement></permissions><abstract><sec><title>Background</title><p>Schistosomiasis causes long-term illness and significant economic burden. Morbidity control through integration within existing health care delivery systems is considered a potentially sustainable and cost-effective approach, but there is paucity of information about health-seeking behaviour.</p></sec><sec><title>Methods</title><p>A questionnaire-based study involving 2,002 subjects was conducted in three regions of Ghana to investigate health-seeking behaviour and utilization of health facilities for symptoms related to urinary (blood in urine and painful urination) and intestinal schistosomiasis (diarrhea, blood in stool, swollen abdomen and abdominal pain). Fever (for malaria) was included for comparison.</p></sec><sec><title>Results</title><p>Only 40% of patients with urinary symptoms sought care compared to >70% with intestinal symptoms and >90% with fever. Overall, about 20% of schistosomiasis-related symptoms were reported to a health facility (hospital or clinic), compared to about 30% for fever. Allopathic self-medication was commonly practiced as alternative action. Health-care seeking was relatively lower for patients with chronic symptoms, but if they took action, they were more likely to visit a health facility. In a multivariate logistic regression analysis, perceived severity was the main predictor for seeking health care or visiting a health facility. Age, socio-economic status, somebody else paying for health care, and time for hospital visit occasionally showed a significant impact, but no clear trend. The effect of geographic location was less marked, although people in the central region, and to a lesser extent the north, were usually less inclined to seek health care than people in the south. Perceived quality of health facility did not demonstrate impact.</p></sec><sec><title>Conclusion</title><p>Perceived severity of the disease is the most important determinant of seeking health care or visiting a health facility in Ghana. Schistosomiasis control by passive case-finding within the regular health care delivery looks promising, but the number not visiting a health facility is large and calls for supplementary control options.</p></sec></abstract><abstract abstract-type="summary"><title>Author Summary</title><p>The World Health Organization recommends that long-term benefit of schistosomiasis control should include treatment in local health facilities. This means that patients should visit a hospital or clinic with their complaints. However, little is known about whether they do so. We conducted a study in three regions of Ghana and interviewed two thousand people about whether they recently had schistosomiasis-related symptoms such as blood in urine or blood in faeces, and what they had done about it. We included fever (mostly caused by malaria) for comparison. We found that 40% of patients with urinary symptoms sought care compared to 70% of those with intestinal symptoms and 90% with fever. Overall, only 20% of all schistosomiasis-related symptoms were reported to a hospital or clinic, compared to 30% for fever. Self-medication with allopathic (i.e., orthodox) medicines was the main alternative. Our study showed that the most important determinant for seeking health care or visiting a health facility is perceived severity of the symptom. Factors such as age, sex, socio-economic status and geographic region showed no impact or a clear pattern. We conclude that many schistosomiasis patients do not visit a health facility, the only place with effective drugs, necessitating additional control measures.</p></abstract><counts><page-count count="10"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>Ghana</li><li>Pays-Bas</li><li>Royaume-Uni</li></country><region><li>Hollande-Méridionale</li></region><settlement><li>Rotterdam</li></settlement></list><tree><country name="Pays-Bas"><region name="Hollande-Méridionale"><name sortKey="Danso Appiah, Anthony" sort="Danso Appiah, Anthony" uniqKey="Danso Appiah A" first="Anthony" last="Danso-Appiah">Anthony Danso-Appiah</name></region><name sortKey="De Vlas, Sake J" sort="De Vlas, Sake J" uniqKey="De Vlas S" first="Sake J." last="De Vlas">Sake J. De Vlas</name><name sortKey="Habbema, J Dik F" sort="Habbema, J Dik F" uniqKey="Habbema J" first="J. Dik F." last="Habbema">J. Dik F. Habbema</name><name sortKey="Looman, Caspar W N" sort="Looman, Caspar W N" uniqKey="Looman C" first="Caspar W. N." last="Looman">Caspar W. N. Looman</name><name sortKey="Stolk, Wilma A" sort="Stolk, Wilma A" uniqKey="Stolk W" first="Wilma A." last="Stolk">Wilma A. Stolk</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Danso Appiah, Anthony" sort="Danso Appiah, Anthony" uniqKey="Danso Appiah A" first="Anthony" last="Danso-Appiah">Anthony Danso-Appiah</name></noRegion></country><country name="Ghana"><noRegion><name sortKey="Bosompem, Kwabena M" sort="Bosompem, Kwabena M" uniqKey="Bosompem K" first="Kwabena M." last="Bosompem">Kwabena M. Bosompem</name></noRegion><name sortKey="Otchere, Joseph" sort="Otchere, Joseph" uniqKey="Otchere J" first="Joseph" last="Otchere">Joseph Otchere</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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