Perceived Morbidity, Healthcare-Seeking Behavior and Their Determinants in a Poor-Resource Setting: Observation from India

Abstract

Background

To control the double burden of communicable and non-communicable diseases (NCDs), in the developing world, understanding the patterns of morbidity and healthcare-seeking is critical. The objective of this cross-sectional study was to determine the distribution, predictors and inter-relationship of perceived morbidity and related healthcare-seeking behavior in a poor-resource setting.

Methods

Between October 2013 and July 2014, 43999 consenting subjects were recruited from 10107 households in Malda district of West Bengal state in India, through multistage random sampling, using probability proportional-to-size. Information on socio-demographics, behaviors, recent ailments, perceived severity and healthcare-seeking were analyzed in SAS-9.3.2.

Results

Recent illnesses were reported by 55.91% (n=24600) participants. Among diagnosed ailments (n=23626), 50.92% (n=12031) were NCDs. Respiratory (17.28%,n=7605)), gastrointestinal (13.48%,n=5929) and musculoskeletal (6.25%,n=2749) problems were predominant. Non-qualified practitioners treated 53.16% (n=13074) episodes. Older children/adolescents [adjusted odds ratio for private healthcare providers(AOR _Pri)=0.76, 95% confidence interval=0.71-0.83) and for Govt. healthcare provider(AOR _Govt)=0.80(0.68-0.95)], females [AOR _Govt=0.80(0.73-0.88)], Muslims [AOR _Pri=0.85(0.69-0.76) and AOR _Govt=0.92(0.87-0.96)], backward castes [AOR _Govt=0.93(0.91-0.96)] and rural residents [AOR _Pri=0.82(0.75-0.89) and AOR _Govt=0.72(0.64-0.81)] had lower odds of visiting qualified practitioners. Apparently less severe NCDs [acid-peptic disorders: AOR _Pri=0.41(0.37-0.46) & AOR _Govt=0.41(0.37-0.46), osteoarthritis: AOR _Pri=0.72(0.59-0.68) & AOR _Govt=0.58(0.43-0.78)], gastrointestinal [AOR _Pri=0.28(0.24-0.33) & AOR _Govt=0.69(0.58-0.81)], respiratory [AOR _Pri=0.35(0.32-0.39) & AOR _Govt=0.46(0.41-0.52)] and skin infections [AOR _Pri=0.65(0.55-0.77)] were also less often treated by qualified practitioners. Better education [AOR _Pri=1.91(1.65-2.22) for ≥graduation], sanitation [AOR _Pri=1.58(1.42-1.75)] and access to safe water [AOR _Pri=1.33(1.05-1.67)] were associated with healthcare-seeking from qualified private practitioners. Longstanding NCDs [chronic obstructive pulmonary diseases: AOR _Pri=1.80(1.46-2.23), hypertension: AOR _Pri=1.94(1.60-2.36), diabetes: AOR _Pri=4.94(3.55-6.87)] and serious infections [typhoid: AOR _Pri=2.86(2.04-4.03)] were also more commonly treated by qualified private practitioners. Potential limitations included temporal ambiguity, reverse causation, generalizability issues and misclassification.

Conclusion

In this poor-resource setting with high morbidity, ailments and their perceived severity were important predictors for healthcare-seeking. Interventions to improve awareness and healthcare-seeking among under-privileged and vulnerable population with efforts to improve the knowledge and practice of non-qualified practitioners probably required urgently.