Abstract
BackgroundInfectious diseases present a potentially substantial yet undefined burden on the health of the adult Azerbaijani population. Efforts to quantify this burden in Azerbaijan are currently based almost exclusively on passive disease surveillance, and therefore hinge on the health utilization practices of the population. Understanding the prevalence of infectious syndromes and health utilization practices is paramount to disease surveillance, public health planning, and health care system reform.MethodsA two-stage, probability proportional to size sampling design was used to select a representative sample of three regions of northern Azerbaijan with village populations less than 500 people. Demographic, clinical, and epidemiologic parameters were assessed using prevalence odds ratios, chi-squared, and the Fisher exact test. Associations with p < 0.10 were included in the regression analysis and removed by backward elimination. Respondents included 796 adults from 39 villages.ResultsSelf-medication with antibiotics was the predominant utilization practice reported (19.4%). Only 1.3% of respondents reported seeing a health care provider for an infection, and 3.4% missed work or stayed in bed during the day in the last 5 years. In contrast, 338 illness episodes were reported in a 5 year period. Antibiotic use was significantly associated with gender, region, history of febrile illness, sleep disturbances, and arthritis controlling for age, ethnicity, and education. Influenza-like illness was the most prevalent infectious syndrome reported (33.3%).ConclusionsWe observed a remarkably low utilization of health services, despite reported symptoms that would merit use. Widespread availability of antibiotics may deter health care use, and may contribute to the development of antibiotic resistance in this population. Information on utilization of health services during an infection is essential for development of effective intervention strategies, and data on the prevalence of infectious syndromes provides information not otherwise available in populations with low health care utilization.
Highlights
Infectious diseases present a potentially substantial yet undefined burden on the health of the adult Azerbaijani population
In this study we describe the relative influence of these infectious syndromes and non-specific complaints on health seeking behaviors, and the burden of these illnesses on the health of the rural adult Azerbaijani population in three regions of Azerbaijan
Common infectious syndromes of influenza-like illness (ILI) and gastrointestinal illness (GI) infection as well as non-specific complaints such as sleep disturbances and arthritis were frequently reported, and were significantly associated with antibiotic usage
Summary
Infectious diseases present a potentially substantial yet undefined burden on the health of the adult Azerbaijani population. Efforts to quantify this burden in Azerbaijan are currently based almost exclusively on passive disease surveillance, and hinge on the health utilization practices of the population. Understanding the prevalence of infectious syndromes and health utilization practices is paramount to disease surveillance, public health planning, and health care system reform. Mortality attributable to infectious and parasitic diseases comprises 16.4 deaths per 100,000 population in Azerbaijan, compared to 8.9/100,000 in the European Union and 25.3/100,000 among the countries comprising the Commonwealth of Independent States [1]. The under 5 mortality rate in 1990 was 98 deaths per 1,000 live births and has subsequently improved to 36/1,000 in 2008, but remains substantially higher than that of Turkey (22/ 1,000), Georgia (30/1,000), and Iran (32/1,000) [5]
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