Abstract
BackgroundSeveral public health interventions to improve management of patients with fever are largely focused on the public sector yet a high proportion of patients seek care outside the formal healthcare sector. Few studies have provided information on the determinants of utilization of the private sector as against formal public sector. Understanding the differences between those who attend public and private health institutions, and their pathway to care, has significant practical implications. The chemical shop is an important source of care for acute fever in Ghana.MethodsCase–control methodology was used to identify factors associated with seeking care for fever in the Dangme West District, Ghana. People presenting to health centres, or hospital outpatients, with a history or current fever were compared to counterparts from the same community with fever visiting a chemical shop.ResultsOf 600 patients, 150 each, were recruited from the district hospital and two health centres, respectively, and 300 controls from 51 chemical shops. Overall, 103 (17.2 %) patients tested slide positive for malaria. Specifically, 13.7 % (41/300) of chemical shop patients, 30.7 % (46/150) health centre and 10.7 % (16/150) hospital patients were slide positive. While it was the first option for care for 92.7 % (278/300) chemical shop patients, 42.7 % (64/150) of health centre patients first sought care from a chemical shop. More health centre patients (61.3 %; 92/150) presented with fever after more than 3 days than chemical shop patients (27.7 %; 83/300) [AOR = 0.19; p < 0.001 CI 0.11–0.30]. Although the hospital was the first option for 83.3 % (125/150) of hospital patients, most (63.3 %; 95/150) patients arrived there over 3 days after their symptoms begun. Proximity was significantly associated with utilization of each source of care. Education, but not other socioeconomic or demographic factors were significantly associated with chemical shop use.ConclusionsThe private drug retail sector is the first option for the majority of patients, including poorer patients, with fever in this setting. Most patients with fever arrive at chemical shops with less delay and fewer signs of severity than at public health facilities. Improving chemical shop skills is a good opportunity to diagnose, treat or refer people with fever early.
Highlights
Several public health interventions to improve management of patients with fever are largely focused on the public sector yet a high proportion of patients seek care outside the formal healthcare sector
Demographic characteristics of patients Health centre compared to chemical shop There was little difference in the age of those presenting at chemical shops versus health centres, by mean age (19.9 vs 22.2 years, respectively), in children under 5 years of age with fever presenting for care, a higher proportion presenting at the health centre [30 %; 45/150] as compared to the chemical shop [21.3 %; 64/300] were children
The hospital was the first option for 83.3 % (125/150) of those who sought care there, most (63.3 %; 95/150) patients still arrived there more than 3 days after their symptoms begun as compared to the chemical shop (27.7 %; 83/300). [AOR = 0.29; p < 0.001 confidence intervals (CIs) 0.18– 0.46]
Summary
Several public health interventions to improve management of patients with fever are largely focused on the public sector yet a high proportion of patients seek care outside the formal healthcare sector. Acute febrile illness is the commonest syndrome presenting in most African healthcare settings in both the formal public health sector and the informal private sector [1]. A high proportion, and often the majority, of those who seek care do not do so in the formal healthcare sector [2]. Studies in Malawi and Ghana found that for a higher proportion of people or caregivers with fever, their first option was to obtain drugs over the counter from a drug retail or chemical shop [8, 9]. In his review of fever and its treatment in sub-Saharan Africa, found that in rural areas, treatment for children in the richest quintile is about 30 % more likely to be sought from a pharmacy or a shop than for children in the poorest quintile [10]
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