Journal Article

Treatment-seeking behaviour for febrile illnesses and its implications for malaria control and elimination in Savannakhet Province, Lao PDR (Laos): a mixed method study

White, Nicholas J., Sirithiranont, Pasathorn, Mayxay, Mayfong, Newton, Paul N., Soundala, Xayaphone, Day, Nicholas P. J., Parker, Daniel M., Phommasone, Koukeo, Henriques, Gisela, Pongvongsa, Tiengkham, Adhikari, Bipin, von Seidlein, Lorenz, Dondorp, Arjen M., Cheah, Phaik Yeong, Pell, Christopher, Koummarasy, Palingnaphone

2019

Overview

Background How people respond to febrile illness is critical to malaria prevention, control, and ultimately elimination. This article explores factors affecting treatment-seeking behaviour for febrile illnesses in a remote area of Lao PDR. Methods Household heads or their representatives ( n  = 281) were interviewed using a structured questionnaire. A total of twelve focus group discussions (FGDs) each with eight to ten participants were conducted in four villages. In addition, observations were recorded as field notes ( n  = 130) and were used to collect information on the local context, including the treatment seeking behaviour and the health services. Results Almost three-quarters (201/281) of respondents reported fever in past two months. Most (92%, 185/201) sought treatment of which 80% (149/185) sought treatment at a health centre. Geographic proximity to a health centre (AOR = 6.5; CI = 1.74–24.25; for those < 3.5 km versus those > 3.6 km) and previous experience of attending a health centre (AOR = 4.7; CI = 1.2–19.1) were strong predictors of visiting a health centre for febrile symptoms. During FGDs, respondents described seeking treatment from traditional healers and at health centre for mild to moderate illnesses. Respondents also explained how if symptoms, including fever, were severe or persisted after receiving treatment elsewhere, they sought assistance at health centres. Access to local health centres/hospitals was often constrained by a lack of transportation and an ability to meet the direct and indirect costs of a visit. Conclusion In Nong District, a rural area bordering Vietnam, people seek care from health centres offering allopathic medicine and from spiritual healers. Decisions about where and when to attend health care depended on their economic status, mobility (distance to the health centre, road conditions, availability of transport), symptoms severity and illness recognition. Current and future malaria control/elimination programmes could benefit from greater collaboration with the locally accessible sources of treatments, such as health volunteers and traditional healers.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Behavior / Care and treatment / Community / Data collection / Development and progression / Elimination / Febrile illness / Female / Fever / Fever - etiology / Fever - therapy / Focus Groups / Health Administration / Health behavior / Health care / Health Informatics / Health seeking / Health Services / Health systems and services in low and middle income settings / Households / Humans / Illnesses / Laos / Malaria / Malaria - complications / Malaria - prevention & control / Male / Maternal & child health / Medicine / Medicine & Public Health / Medicine, Traditional / Middle Aged / Mixed methods research / Nursing Research / On the counter / Parasites / Patient Acceptance of Health Care / Pilot projects / Population / Prevention / Public Health / Public opinion / Questionnaires / Research Article / Resistance / Sociodemographics / Socioeconomic Factors / Surveys and Questionnaires / Towns / Tuberculosis