Perceptions of chest pain and healthcare seeking behavior for chest pain in northern Tanzania: A community-based survey.

Julian T Hertz,Gwamaka William,Ryan A Simmons,Revogatus A Tesha,Sophie W Galson,Gerald S Bloomfield,John A Crump,Matthew P Rubach,Deng B Madut,Francis M Sakita,Venance P Maro,Lars-Peter Kamolz

doi:10.1371/journal.pone.0212139

Abstract

BackgroundLittle is known about community perceptions of chest pain and healthcare seeking behavior for chest pain in sub-Saharan Africa.MethodsA two-stage randomized population-based cluster survey with selection proportional to population size was performed in northern Tanzania. Self-identified household healthcare decision-makers from randomly selected households were asked to list all possible causes of chest pain in an adult and asked where they would go if an adult household member had chest pain.ResultsOf 718 respondents, 485 (67.5%) were females. The most commonly cited causes of chest pain were weather and exercise, identified by 342 (47.6%) and 318 (44.3%) respondents. Two (0.3%) respondents identified ‘heart attack’ as a possible cause of chest pain. A hospital was selected as the preferred healthcare facility for an adult with chest pain by 277 (38.6%) respondents. Females were less likely to prefer a hospital than males (OR 0.65, 95% CI 0.47–0.90, p = 0.008).ConclusionsThere is little community awareness of cardiac causes of chest pain in northern Tanzania, and most adults reported that they would not present to a hospital for this symptom. There is an urgent need for educational interventions to address this knowledge deficit and guide appropriate care-seeking behavior.

Highlights

The symptom of chest pain is associated with serious conditions and is present in the large majority of patients with acute coronary syndrome (ACS) in high-income countries worldwide [1, 2]
A hospital was selected as the preferred healthcare facility for an adult with chest pain by 277 (38.6%) respondents
There is little community awareness of cardiac causes of chest pain in northern Tanzania, and most adults reported that they would not present to a hospital for this symptom

Summary

Introduction

The symptom of chest pain is associated with serious conditions and is present in the large majority of patients with acute coronary syndrome (ACS) in high-income countries worldwide [1, 2]. Much less is known about the symptomatology of ACS in sub-Saharan Africa, but preliminary data from small single-center studies in the region have found that up to 84% of patients diagnosed with ACS presented with chest pain [3, 4]. In northern Tanzania, for example, the local prevalence of hypertension among adults has risen from 7% in 1993 [7] to 28% in 2014 [8]. Despite the well-documented surge in these risk factors, very little is known about the prevalence of ischemic heart disease across sub-Saharan Africa, and ACS remains a rare diagnosis among hospitalised adults [9]. If the projections for Tanzania are correct, there are many possible reasons for possible under-reporting of ACS in the region, including physician practices, local sociomedical culture, resource limitations, research priorities, systems challenges, and patient beliefs and behaviors.

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Discussion

Conclusion