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Brunner NC, Awor P, Hetzel MW. Definitions of Severity in Treatment Seeking Studies of Febrile Illness in Children in Low and Middle Income Countries: A Scoping Review. Int J Public Health 2021; 66:634000. [PMID: 34526874 PMCID: PMC8435535 DOI: 10.3389/ijph.2021.634000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 08/06/2021] [Indexed: 01/02/2023] Open
Abstract
Objectives: Understanding treatment seeking for severe febrile illness (SFI) is methodologically challenging. In this scoping review, we investigate definitions of severe febrile illness in treatment seeking studies on children under 5 years of age in low and middle income countries. We analyze the association of SFI definitions with different concepts of treatment seeking and identify related research gaps. Methods: We searched Pubmed, Scopus and WHOLIS, and screened references of included publications for eligibility. Results: Definitions of SFI had either a biomedical perspective (predominantly in quantitative studies) or a caregiver perspective (predominantly in qualitative studies). In quantitative analyses of treatment seeking, severity was more often conceptualized as a determinant rather than an outcome of a treatment seeking process. The majority of quantitative analyses only included surviving children or did not explicitly mention dead children. Conclusion: Different research questions lead to diverse definitions and concepts of severity and treatment seeking outcomes, which limits the comparability of the available evidence. Systematic exclusion of dead children is likely to bias inferences on the association of treatment seeking and health outcomes of children with SFI in low and middle income countries.
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Affiliation(s)
- Nina C Brunner
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Manuel W Hetzel
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Seidu AA, Ahinkorah BO, Agbaglo E, Oduro JK, Amoah A, Yaya S. Factors associated with the utilisation of skilled delivery services in Papua New Guinea: evidence from the 2016-2018 Demographic and Health Survey. Int Health 2021; 14:64-73. [PMID: 33684205 PMCID: PMC8769953 DOI: 10.1093/inthealth/ihab007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/03/2021] [Accepted: 02/09/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We sought to determine the prevalence and factors associated with the use of skilled assistance during delivery in Papua New Guinea. METHODS We analysed nationally representative data from 5210 women in Papua New Guinea using the 2016-2018 Demographic and Health survey. Both bivariate and multivariable analyses were performed. Statistical significance was set at p<0.05. RESULTS The prevalence of skilled assistance during delivery was 57.6%. The richest women (adjusted OR [AOR]=3.503, 95% CI 2.477 to 4.954), working women (AOR=1.221, 95% CI 1.037 to 1.439), women with primary (AOR=1.342, 95% CI 1.099 to 1.639), secondary or higher education (AOR=2.030, 95% CI 1.529 to 2.695), women whose partners had a secondary or higher level of education (AOR=1.712, 95% CI 1.343 to 2.181], women who indicated distance was not a big problem in terms of healthcare (AOR=1.424, 95% CI 1.181 to 1.718), women who had ≥4 antenatal care (ANC) visits (AOR=10.63, 95% CI 8.608 to 13.140), women from the Islands region (AOR=1.305, 95% CI 1.045 to 1.628), those who read newspapers or magazines (AOR=1.310, 95% CI 1.027 to 1.669) and women who watched television (AOR=1.477, 95% CI 1.054 to 2.069) less than once a week had higher odds of utilising skilled attendants during delivery. On the contrary, women in the Momase region (AOR=0.543, 95% CI 0.438 to 0.672), women in rural areas (AOR=0.409, 95% CI 0.306 to 0.546), as well as women with a parity of 3 (AOR=0.666, 95% CI 0.505 to 0.878) or ≥4 (AOR=0.645, 95% CI 0.490 to 0.850) had lower odds of utilising skilled attendance during delivery. CONCLUSION There is relatively low use of skilled delivery services in Papua New Guinea. Wealth, employment status, educational level, parity and number of ANC visits, as well as access to healthcare and place of residence, influence the utilisation of skilled delivery services.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Vertinary Sciences, James Cook University, Townsville, QLD 4811, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Joseph Kojo Oduro
- Department of Population and Health, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Abigail Amoah
- Department of Population and Health, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON KIN 6N5, Canada.,The George Institute for Global Health, Imperial College London, London W120BZ, UK
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Tsukahara T, Sugahara T, Ogura S, Hombhanje FW. Effect of pecuniary costs and time costs on choice of healthcare providers among caregivers of febrile children in rural Papua New Guinea. HEALTH ECONOMICS REVIEW 2019; 9:33. [PMID: 31828554 PMCID: PMC6907116 DOI: 10.1186/s13561-019-0250-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND User fees, transportation costs, and time costs impair access to healthcare by rural communities in low and middle income countries. However, effects of time costs on demand for healthcare are less understood than effects of user fees for health providers. In addition, prospective patients might not know about all health services available. This study aims to investigate how the family caregivers of febrile children respond to the pecuniary costs and time costs in their choice of health providers in rural Papua New Guinea. METHODS Using an original questionnaire, we surveyed households in the catchment area surrounding Dagua Health Center in East Sepik Province, Papua New Guinea, during February-March 2015. We estimated the probability of choosing one among four categories of providers (i.e., the health center, aid posts, village health volunteers [VHVs], or home-treatment) via a mixed logit model in which we restrict alternatives to those for which family caregivers knew cost information. RESULTS Of 1173 family caregivers, 96% sought treatment for febrile children from four categories of providers. Almost all knew the location of the health center and a health volunteer, but only 50% knew the location of aid posts. Analysis by discrete choice model showed that pecuniary costs and time costs were inversely associated with the probability of choosing any type of provider. We then changed pecuniary costs and time costs counterfactually to calculate and compare the probability of choosing each provider. Time costs affected the choice more than pecuniary costs, and individual heterogeneity appeared among caregivers with respect to pecuniary costs. When pecuniary or time costs of VHVs are altered, substitution between VHVs and home-treatment appeared. CONCLUSIONS Our findings suggest that policies to increase awareness of aid posts and reduce time costs in addition to treatment fees for each category of healthcare provider could help developing economies to improve access to essential healthcare services.
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Affiliation(s)
- Takahiro Tsukahara
- Department of International Affairs and Tropical Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
- School of Economics, Hosei University Graduate School, 2-15-2 Ichigaya Tamachi, Shinjuku-ku, Tokyo, 162-0843 Japan
| | - Takuma Sugahara
- School of Economics, Hosei University Graduate School, 2-15-2 Ichigaya Tamachi, Shinjuku-ku, Tokyo, 162-0843 Japan
| | - Seiritsu Ogura
- School of Economics, Hosei University Graduate School, 2-15-2 Ichigaya Tamachi, Shinjuku-ku, Tokyo, 162-0843 Japan
| | - Francis Wanak Hombhanje
- Centre for Health Research and Diagnostics, Divine Word University-Rabaul Campus, Kokopo, Papua New Guinea
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Yoshii A, Sekihara M, Furusawa T, Hombhanje F, Tsukahara T. Factors associated with children's health facility visits for primaquine treatment in rural Papua New Guinea. Malar J 2019; 18:42. [PMID: 30786891 PMCID: PMC6383275 DOI: 10.1186/s12936-019-2675-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/14/2019] [Indexed: 12/20/2022] Open
Abstract
Background To control and eventually eliminate vivax malaria, radical treatment with primaquine (PQ) is essential after completion of blood-stage treatment. Although in many malaria-endemic countries, village health volunteers (VHVs) are engaged in diagnostic treatment of malaria in remote communities, they principally provide blood-stage treatment. In such a situation, access to PQ following blood-stage treatment can be a barrier to complete treatment. However, studies on access to PQ treatment have been scarce and limited in health facility-based settings. This study aimed to identify factors associated with access to PQ treatment in rural Papua New Guinea (PNG) from the community case management perspective. Methods A community-based, cross-sectional survey was conducted to collect sociodemographic information on children under 15 years of age, their households, and their caretakers in East Sepik Province, PNG. Data collection lasted from February to March, 2015. Information on the diagnoses of potential non-falciparum malaria and prescription of PQ in preceding year (January to December 2014) were obtained from child health-record books. Then, multilevel logistic regression model was used to determine the factors associated with formal health facility visits for PQ treatment among children with potential non-falciparum malaria. Results Of 420 episodes diagnosed as potential non-falciparum malaria, 46 (11%) were immediately given PQ. The rest were instructed to visit formal health facilities (HFs) for PQ, and the patients obtained PQ during the second visit to HFs was 44%. Consequently, the overall proportion of PQ prescription was 50%. Logistic regression analysis suggested that among the patients who were instructed to visit HFs for PQ treatment, the initial visit to VHV and higher transportation costs to HF were inversely associated with PQ prescription during the second visit to an HF. Conclusions Few children received PQ treatment during the second visit to HFs following diagnosis of potential non-falciparum malaria. These findings suggest a need to establish a policy to reduce structural and economic barriers and improve rural inhabitant access to PQ treatment. Electronic supplementary material The online version of this article (10.1186/s12936-019-2675-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akiko Yoshii
- TWMU Career Development Center for Medical Professionals, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Makoto Sekihara
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Department of Tropical Medicine and Parasitology, Juntendo University School of Medicine, 6th Floor, Bldg. No.9, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takuro Furusawa
- Department of Ecology and Environment, Graduate School of Asian and African Area Studies, Kyoto University, Room#AA431, Research Bldg. No.2, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Francis Hombhanje
- Centre for Health Research and Diagnostics, Divine Word University-Rabaul Campus, Kokopo, Papua New Guinea
| | - Takahiro Tsukahara
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. .,School of Economics, Hosei University Graduate School, 2-15-2 Ichigaya Tamachi, Shinjuku-ku, Tokyo, 162-0843, Japan.
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5
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Tsukahara T, Sugahara T, Furusawa T, Hombhanje FW. Comparison of Health Service Utilization for Febrile Children Before and After Introduction of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy in Rural Papua New Guinea. Front Public Health 2018; 6:75. [PMID: 29594096 PMCID: PMC5859013 DOI: 10.3389/fpubh.2018.00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/26/2018] [Indexed: 11/16/2022] Open
Abstract
Background In Papua New Guinea (PNG), a malaria treatment policy using rapid diagnostic tests (RDTs) plus artemisinin-based combination therapy (ACT) was widely introduced to rural communities in 2012. The objectives of the study were to evaluate the effect of this RDT/ACT introduction to a rural PNG population on health service utilization and to compare factors associated with health service utilization before and after the RDT/ACT introduction. Methods Household surveys with structured questionnaires were conducted before and after the introduction of RDT/ACT in a catchment area of a health center in East Sepik Province, PNG. We interviewed caregivers with children less than 15 years of age and collected data on fever episodes in the preceding 2 weeks. Using propensity score matching, febrile children before the introduction of RDT/ACT were matched to febrile children after the introduction. Then, the adjusted difference in the proportion of health service utilization [i.e., the average treatment effect (ATE) of the introduction of RDT/ACT on health service utilization] was estimated. We also employed a multilevel Poisson regression model to investigate factors influencing the use of health services. Results Of 4,690 children, 911 (19%) were reported to have a fever episode. The unadjusted proportion of health service utilization was 51.7 and 57.2% before and after the RDT/ACT introduction, respectively. After matching, no significant difference in the health service utilization was observed before and after the introduction of RDT/ACT (ATE: 0.063, 95% confidence interval −0.024 to 0.150). Multilevel regression analysis showed that the consistent factors associated with a higher utilization of health services were severe illness and being female. Conclusion The utilization of health services was not significantly different before and after the introduction of RDT/ACT. Villagers may have neither sufficient informations on the new protocol nor high acceptance of RDT/ACT. The observed gender bias in health service utilization could be due to female caregivers’ preferences toward girls.
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Affiliation(s)
- Takahiro Tsukahara
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan.,Graduate School of Economics, Hosei University, Tokyo, Japan
| | - Takuma Sugahara
- Graduate School of Economics, Hosei University, Tokyo, Japan
| | - Takuro Furusawa
- Department of Ecology and Environment, Graduate School of Asian and African Area Studies, Kyoto University, Kyoto, Japan
| | - Francis Wanak Hombhanje
- Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
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Inoue Y, Takahashi D, Kondo N, Yoshii A, Sekihara M, Hombhanje FW, Tsukahara T. Village health volunteers’ individual social capital and caretakers’ health service utilization for febrile children in Malaria-endemic villages in Papua New Guinea. Trans R Soc Trop Med Hyg 2018; 111:490-496. [DOI: 10.1093/trstmh/try003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/05/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yosuke Inoue
- Carolina Population Center, 123 West Franklin St., Chapel Hill, NC 27516, USA
| | - Daichi Takahashi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Naoki Kondo
- Department of Health and Social Behavior, School of Public Health, University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
- Department of Health Education and Health Sociology, School of Public Health, University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Akiko Yoshii
- Department of International Affairs and Tropical Medicine, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Makoto Sekihara
- Department of International Affairs and Tropical Medicine, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Francis W Hombhanje
- Divine Word University, Rabaul Campus, East New Britain 613, Kokopo, Papua New Guinea
| | - Takahiro Tsukahara
- Department of International Affairs and Tropical Medicine, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo 162-8666, Japan
- School of Economics, Hosei University Graduate School, Shinjuku-ku, Tokyo 162-0843, Japan
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Feterl M, Graves P, Seehofer L, Warner J, Wood P, Miles K, Hutton R. The Epidemiology of Malaria in Kutubu, Southern Highlands Province, Papua New Guinea, before and during a Private Sector Initiative for Malaria Control. Trop Med Infect Dis 2017; 2:E2. [PMID: 30270861 PMCID: PMC6082053 DOI: 10.3390/tropicalmed2010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/22/2017] [Accepted: 02/06/2017] [Indexed: 11/21/2022] Open
Abstract
Papua New Guinea (PNG) has a significant malaria burden, is resource constrained, and has isolated populations with limited access to health services. Home-based management is a key element of the national program that supports strategies of early detection, diagnosis and treatment. We describe the epidemiology of malaria near Lake Kutubu in the Southern Highlands Province through reported data on suspected and confirmed malaria in patients accessing public health facilities or using a novel, incentivised, social marketing approach for malaria treatment at the village level. Monthly case data reported by nine health facilities and 14 village-based providers, known as Marasin Stoa Kipas (MSK), were extracted from outpatient registers and MSK malaria case forms. Descriptive statistics of diagnostic use, monthly incidence, test positivity rate and species distribution were estimated. Summary statistics of service delivery demonstrate patient access and diagnostic coverage in program areas. From May 2005 to September 2013, 15,726 individuals were tested with either rapid diagnostic test and/or microscopy at health facilities, and 42% had a positive result for malaria (n = 6604); of these 67.1% (n = 4431) were positive for P. falciparum (alone or mixed) and 32.9% were positive for non-P. falciparum species (alone or mixed). From October 2007 to September 2013, 9687 individuals were tested with either RDT and/or microscopy at MSK sites and 44.2% (n = 4283) tested positive for malaria; of these, 65.3% (n = 2796) were positive for P. falciparum, while 34.7% (n = 1487) were positive for non-P. falciparum species. Up to April 2010 there was an intermittent and upward trend in the reported incidence of all species of confirmed malaria, reaching 50 per 1000 population per month for both sites combined, followed by a steady decline to four per 1000 population per month in 2013, with P. vivax the most common infection. This study is the most recent longitudinal overview of malaria in the Southern Highlands since 2003. It outlines patient access to a community-based model of care. The analysis shows changes in health facility versus MSK use, a strongly decreasing trend in incidence of confirmed malaria from 2010 to 2013, and a shift from predominantly P. falciparum to P. vivax infection.
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Affiliation(s)
- Marshall Feterl
- Australian Institute of Tropical Health and Medicine, Division of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia.
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns 6811, Australia.
| | - Patricia Graves
- Australian Institute of Tropical Health and Medicine, Division of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia.
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns 6811, Australia.
| | - Liesel Seehofer
- Oil Search Foundation, PO Box 842, Port Moresby, Papua New Guinea.
| | - Jeffery Warner
- Australian Institute of Tropical Health and Medicine, Division of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia.
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns 6811, Australia.
| | - Peter Wood
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns 6811, Australia.
| | - Kevin Miles
- Oil Search Foundation, PO Box 842, Port Moresby, Papua New Guinea.
| | - Ross Hutton
- Oil Search Foundation, PO Box 842, Port Moresby, Papua New Guinea.
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