TY - JOUR
T1 - The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh
AU - Herdman, M. Trent
AU - Maude, Richard
AU - Chowdhury, Safiqul
AU - Kingston, Hugh William Fluellen
AU - Jeeyapant, Atthanee
AU - Samad, Rasheda
AU - Karim, Rezaul
AU - Dondorp, Arjen
AU - Hossain, Amir
PY - 2016
Y1 - 2016
N2 - Delays in seeking appropriate healthcare can increase the case fatality
of acute febrile illnesses, and circuitous routes of care-seeking can
have a catastrophic financial impact upon patients in low-income
settings. To investigate the relationship between poverty and
pre-hospital delays for patients with acute febrile illnesses, we
recruited a cross-sectional, convenience sample of 527 acutely ill
adults and children aged over 6 months, with a documented fever ≥38.0°C
and symptoms of up to 14 days’ duration, presenting to a tertiary
referral hospital in Chittagong, Bangladesh, over the course of one year
from September 2011 to September 2012. Participants were classified
according to the socioeconomic status of their households, defined by
the Oxford Poverty and Human Development Initiative’s multidimensional
poverty index (MPI). 51% of participants were classified as
multidimensionally poor (MPI>0.33). Median time from onset of any
symptoms to arrival at hospital was 22 hours longer for MPI poor adults
compared to non-poor adults (123 vs. 101 hours) rising to a
difference of 26 hours with adjustment in a multivariate regression
model (95% confidence interval 7 to 46 hours; P = 0.009). There was no
difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394). Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001)—5.1% vs. 0.0% for poor and non-poor adults (P = 0.010) and 6.4% vs.
1.8% for poor and non-poor children (P = 0.083). Deaths were attributed
to central nervous system infection (11), malaria (3), urinary tract
infection (2), gastrointestinal infection (1) and undifferentiated
sepsis (1). Both poor and non-poor households relied predominantly upon
the (often informal) private sector for medical advice before reaching
the referral hospital, but MPI poor participants were less likely to
have consulted a qualified doctor. Poor participants were more likely to
attribute delays in decision-making and travel to a lack of money
(P<0.001), and more likely to face catastrophic expenditure of more
than 25% of monthly household income (P<0.001). We conclude that
multidimensional poverty is associated with greater pre-hospital delays
and expenditure in this setting. Closer links between health and
development agendas could address these consequences of poverty and
streamline access to adequate healthcare.
AB - Delays in seeking appropriate healthcare can increase the case fatality
of acute febrile illnesses, and circuitous routes of care-seeking can
have a catastrophic financial impact upon patients in low-income
settings. To investigate the relationship between poverty and
pre-hospital delays for patients with acute febrile illnesses, we
recruited a cross-sectional, convenience sample of 527 acutely ill
adults and children aged over 6 months, with a documented fever ≥38.0°C
and symptoms of up to 14 days’ duration, presenting to a tertiary
referral hospital in Chittagong, Bangladesh, over the course of one year
from September 2011 to September 2012. Participants were classified
according to the socioeconomic status of their households, defined by
the Oxford Poverty and Human Development Initiative’s multidimensional
poverty index (MPI). 51% of participants were classified as
multidimensionally poor (MPI>0.33). Median time from onset of any
symptoms to arrival at hospital was 22 hours longer for MPI poor adults
compared to non-poor adults (123 vs. 101 hours) rising to a
difference of 26 hours with adjustment in a multivariate regression
model (95% confidence interval 7 to 46 hours; P = 0.009). There was no
difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394). Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001)—5.1% vs. 0.0% for poor and non-poor adults (P = 0.010) and 6.4% vs.
1.8% for poor and non-poor children (P = 0.083). Deaths were attributed
to central nervous system infection (11), malaria (3), urinary tract
infection (2), gastrointestinal infection (1) and undifferentiated
sepsis (1). Both poor and non-poor households relied predominantly upon
the (often informal) private sector for medical advice before reaching
the referral hospital, but MPI poor participants were less likely to
have consulted a qualified doctor. Poor participants were more likely to
attribute delays in decision-making and travel to a lack of money
(P<0.001), and more likely to face catastrophic expenditure of more
than 25% of monthly household income (P<0.001). We conclude that
multidimensional poverty is associated with greater pre-hospital delays
and expenditure in this setting. Closer links between health and
development agendas could address these consequences of poverty and
streamline access to adequate healthcare.
UR - http://www.scopus.com/inward/record.url?scp=84963773117&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0152965
DO - 10.1371/journal.pone.0152965
M3 - Article
C2 - 27054362
VL - 11
SP - 1
EP - 21
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 4
ER -