Abstract
BackgroundSchistosomiasis 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.MethodsA 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.ResultsOnly 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.ConclusionPerceived 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.
Highlights
Schistosomiasis leads to chronic ill health and significant economic burden [1],[2],[3],[4]
Schistosoma haematobium and S. mansoni are widespread in Africa causing urinary and intestinal schistosomiasis, respectively
We found that 40% of patients with urinary symptoms sought care compared to 70% of those with intestinal symptoms and 90% with fever
Summary
Schistosomiasis leads to chronic ill health and significant economic burden [1],[2],[3],[4]. Schistosoma haematobium and S. mansoni are widespread in Africa causing urinary and intestinal schistosomiasis, respectively. Both species are found in Ghana, sometimes as mixed infection in the same person. For most people who are repeatedly exposed, the severity of disease depends upon the intensity of infection. Haematuria (blood in urine) and dysuria (painful urination) are the main early symptoms of urinary schistosomiasis and diarrhoea, blood in stool and abdominal pain for intestinal schistosomiasis. Over 70% of infected children show one or more early symptoms and signs of disease [5],[6]. 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
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