Healthcare utilization for self-reported fever in Ghana : cross-sectional study

Abstract

Background. “Healthcare utilization” is defined as the quantification of use of health services by people for any cause; this concept goes beyond “access” where services are in place whether people use it or not. Large variations in healthcare utilization between and within countries have been associated with features such as household income, education, health insurance, quality of services, living in an urban or rural place and seasonality, but also with underlying chronic or acute illness. Patterns of healthcare utilization can be a powerful instrument to adjust estimations of incidence of diseases in places where sentinel surveillance is the main mechanism of investigation and could face bias due to underestimations when people do not seek for care with qualified professionals. Understanding the factors that influence people to use healthcare services for self-reported fever can help developing strategies to break barriers to utilization. The main objective of this thesis was to describe healthcare utilization for self-reported fever in two different settings (Agogo and Kumasi) and seasons (wet and dry) in Ghana, as well as to explore any association between demographic variables and healthcare utilization. Methods. Using data from The Health Population Africa (HPAfrica) study that collected data from 2,340 randomly selected households from two different settings (Agogo and Kumasi) in Ghana between May 2017 and January 2019. Self-reported fever was the symptom chosen to evaluate actual and generic health seeking behavior. A descriptive analysis of sociodemographic variables of 360 households were reported fever during last three months and bivariate logistic regression analyses were used to assess the association between household income, education and geographical location (urban and rural) and healthcare utilization. Results. Households with fever episodes during last 3 months reported healthcare utilization as follow: a total of 45.2% chose ‘other healthcare facility’, in 33.1% of cases people chose to visit a ‘pharmacy’, ‘SETA-HCF’ (Severe Typhoid Fever in Africa Program-healthcare facilities) were consulted by 12.2%, households that did ‘not seek for care’ was 5.8%, ‘physicians’ were consulted in 2.2% of cases and ‘traditional healers’ were the option for 1.1% of households. About 80% of households that reported typhoid fever visited a ‘healthcare facility’. People that seek healthcare from alternative non-qualified healthcare personnel represent 40.2%. Statistically significant association between geographical location and healthcare utilization was seen with people living in urban areas showing lower likelihood of seeking appropriate healthcare for fever during wet season (OR = 0.46, 95% confidence interval 0.22 to 0.93). Conclusion. Despite considerable efforts to increase access and strengthen health services at community level in Ghana in recent years, still almost half (40.2%) of people are visiting non-qualified health personnel, indicating a need for improvement. Lower likelihood of appropriate healthcare seeking behavior in urban areas during wet season could be potentially explained by higher concentration of healthcare facilities in rural areas when it is comprised with population concentration but, further research with larger samples and more robust assessments of fever episodes are needed to better establish these associations.