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Health-seeking behaviour in the city of Lubumbashi, Democratic Republic of the Congo: results from a cross-sectional household survey.

Chenge MF, Van der Vennet J, Luboya NO, Vanlerberghe V, Mapatano MA, Criel B - BMC Health Serv Res (2014)

Bottom Line: Analysis of care expenditure reveals that drugs are the only line of expenditure in the informal system and the main source of expenditure in the formal system; costs do not discriminate between first-line health services and hospitals, and the payment system is regressive since the poorest patients pay the same amounts as the richest.There is a lot of room to rationalise this practice.Patients' itineraries in this urban environment are complex; health managers should try and deal with this reality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Ecole de santé publique, Université de Lubumbashi, P,O, Box 1825, Lubumbashi, RD, Congo. fchenge@hotmail.fr.

ABSTRACT

Background: Concerns about the occurrence of disease among household members generally initiate treatment-seeking actions. This study aims to identify the various treatment-seeking options of patients in Lubumbashi, analyze their health-seeking behaviour, identify determinants for the use of formal care, and analyze direct health care expenditure.

Methods: A cross-sectional survey of households in Lubumbashi was conducted in July 2010. Information was collected from a randomly selected sample of 251 households with at least one member who had been ill in the 2 weeks preceding the survey.

Results: Frequently used initial treatment-seeking options consist of self-medication based on modern medicines (54.6%), the use of first-line health services (23.1%) and hospitals (11.9%), with a perceived effectiveness of 51%, 83% and 91% respectively. If people go for a second option, then formal health care services are most often preferred. The majority (60%) of patients' spontaneous itineraries reflect the expected functioning of a local health care system, with a patient flow characterised by the use of a first line health facility prior to the use of hospital-based services. Chronicity of the disease is the main determinant of seeking formal care. Analysis of care expenditure reveals that drugs are the only line of expenditure in the informal system and the main source of expenditure in the formal system; costs do not discriminate between first-line health services and hospitals, and the payment system is regressive since the poorest patients pay the same amounts as the richest.

Conclusions: This study points to the importance of self-medication as the first therapeutic option for the majority of patients in Lubumbashi, whatever the nature of the health problem. There is a lot of room to rationalise this practice. Although formal care is not common initial therapeutic option, it is the source of care most patients turn to, especially when they believe having a chronic disease. Patients' itineraries in this urban environment are complex; health managers should try and deal with this reality. Finally, our study indicates that poor patients face the same level of out-of-pocket payments as the more wealthy ones, hence the need for more equitable health care financing arrangements.

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Related in: MedlinePlus

Factors influencing the choice of care: conceptual framework adapted from Develay et al. [1] and Kroeger [7].
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Figure 1: Factors influencing the choice of care: conceptual framework adapted from Develay et al. [1] and Kroeger [7].

Mentions: Searching for factors that might influence the initial choice of a therapeutic option in the context of Lubumbashi (Figure 1), we first performed a bivariate analysis with all relevant independent variables. Odds Ratios and their respective 95% Confidence Intervals (CI) were calculated. A binary logistic General Estimating Equation model was constructed from the variables that were significant in the bivariate analysis and these non-significant variables that were deemed important or potential confounders on a priori grounds [28]. This kind of model takes into account the clustering of data [29].


Health-seeking behaviour in the city of Lubumbashi, Democratic Republic of the Congo: results from a cross-sectional household survey.

Chenge MF, Van der Vennet J, Luboya NO, Vanlerberghe V, Mapatano MA, Criel B - BMC Health Serv Res (2014)

Factors influencing the choice of care: conceptual framework adapted from Develay et al. [1] and Kroeger [7].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016631&req=5

Figure 1: Factors influencing the choice of care: conceptual framework adapted from Develay et al. [1] and Kroeger [7].
Mentions: Searching for factors that might influence the initial choice of a therapeutic option in the context of Lubumbashi (Figure 1), we first performed a bivariate analysis with all relevant independent variables. Odds Ratios and their respective 95% Confidence Intervals (CI) were calculated. A binary logistic General Estimating Equation model was constructed from the variables that were significant in the bivariate analysis and these non-significant variables that were deemed important or potential confounders on a priori grounds [28]. This kind of model takes into account the clustering of data [29].

Bottom Line: Analysis of care expenditure reveals that drugs are the only line of expenditure in the informal system and the main source of expenditure in the formal system; costs do not discriminate between first-line health services and hospitals, and the payment system is regressive since the poorest patients pay the same amounts as the richest.There is a lot of room to rationalise this practice.Patients' itineraries in this urban environment are complex; health managers should try and deal with this reality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Ecole de santé publique, Université de Lubumbashi, P,O, Box 1825, Lubumbashi, RD, Congo. fchenge@hotmail.fr.

ABSTRACT

Background: Concerns about the occurrence of disease among household members generally initiate treatment-seeking actions. This study aims to identify the various treatment-seeking options of patients in Lubumbashi, analyze their health-seeking behaviour, identify determinants for the use of formal care, and analyze direct health care expenditure.

Methods: A cross-sectional survey of households in Lubumbashi was conducted in July 2010. Information was collected from a randomly selected sample of 251 households with at least one member who had been ill in the 2 weeks preceding the survey.

Results: Frequently used initial treatment-seeking options consist of self-medication based on modern medicines (54.6%), the use of first-line health services (23.1%) and hospitals (11.9%), with a perceived effectiveness of 51%, 83% and 91% respectively. If people go for a second option, then formal health care services are most often preferred. The majority (60%) of patients' spontaneous itineraries reflect the expected functioning of a local health care system, with a patient flow characterised by the use of a first line health facility prior to the use of hospital-based services. Chronicity of the disease is the main determinant of seeking formal care. Analysis of care expenditure reveals that drugs are the only line of expenditure in the informal system and the main source of expenditure in the formal system; costs do not discriminate between first-line health services and hospitals, and the payment system is regressive since the poorest patients pay the same amounts as the richest.

Conclusions: This study points to the importance of self-medication as the first therapeutic option for the majority of patients in Lubumbashi, whatever the nature of the health problem. There is a lot of room to rationalise this practice. Although formal care is not common initial therapeutic option, it is the source of care most patients turn to, especially when they believe having a chronic disease. Patients' itineraries in this urban environment are complex; health managers should try and deal with this reality. Finally, our study indicates that poor patients face the same level of out-of-pocket payments as the more wealthy ones, hence the need for more equitable health care financing arrangements.

Show MeSH
Related in: MedlinePlus