Abstract
BackgroundThis paper studies the determinants of utilization of health care services, especially for treatment of febrile illness in the malaria endemic area of north-east India.MethodsAn area served by two districts of Upper Assam representing people living in malaria endemic area was selected for household survey. A sample of 1,989 households, in which at least one member of household suffered from febrile illness during last three months and received treatment from health service providers, were selected randomly and interviewed by using the structured questionnaire. The individual characteristics of patients including social indicators, area of residence and distance of health service centers has been used to discriminate or group the patients with respect to their initial and final choice of service providers.ResultsOf 1,989 surveyed households, initial choice of treatment-seeking for febrile illness was self-medication (17.8%), traditional healer (Vaidya)(39.2%), government (29.3%) and private (13.7%) health services. Multinomial logistic regression (MLR) analysis exhibits the influence of occupation, area of residence and ethnicity on choice of health service providers. The traditional system of medicine was commonly used by the people living in remote areas compared with towns. As all the febrile cases finally received treatment either from government or private health service providers, the odds (Multivariate Rate Ratio) was almost three-times higher in favour of government services for lower households income people compared to private.ConclusionThe study indicates the popular use of self-medication and traditional system especially in remote areas, which may be the main cause of delay in diagnosis of malaria. The malaria training given to the paramedical staff to assist the health care delivery needs to be intensified and expanded in north-east India. The people who are economically poor and living in remote areas mainly visit the government health service providers for seeking treatment. So, the improvement of quality health services in government health sector and provision of health education to people would increase the utilization of government health services and thereby improve the health quality of the people.
Highlights
This paper studies the determinants of utilization of health care services, especially for treatment of febrile illness in the malaria endemic area of north-east India
In India, malaria is reported from many states, but several deaths of epidemic proportion reported every year from different parts of north-east India [5,6,7]
The malaria cases are detected throughout the year [10], but higher incidence is reported during May to October [11]
Summary
This paper studies the determinants of utilization of health care services, especially for treatment of febrile illness in the malaria endemic area of north-east India. According to WHO report, almost 300 million cases of malaria occur worldwide and more than one million people die due to malaria every year [4]. In India, malaria is reported from many states, but several deaths of epidemic proportion reported every year from different parts of north-east India [5,6,7]. Assam, being the most populated (27.85 million) and geographically second largest State (78,523 km2) of north-east India, is contributing more than 5% of the total number of cases of malaria reported in India. The malaria cases are detected throughout the year [10], but higher incidence is reported during May to October [11]. There is often delay in reporting illness to health care providers and during these periods certain unorthodox practices are adopted as cost-saving measures
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