Academic journal article Journal of Health Population and Nutrition

Factors Associated with Reported Diarrhoea Episodes and Treatment-Seeking in an Urban Slum of Kolkata, India

Academic journal article Journal of Health Population and Nutrition

Factors Associated with Reported Diarrhoea Episodes and Treatment-Seeking in an Urban Slum of Kolkata, India

Article excerpt


An accurate understanding of healthcare use is needed to inform and implement appropriate policies. Several models have been developed to understand treatment preferences better but the one by Andersen is most commonly used (1-3). In this model, factors determining the choices of healthcare providers include severity of disease, perceived vulnerability, socioeconomic factors, and education. The relative importance of individual factors varies considerably between settings.

Many studies have identified economic status as the most significant predictor of medical-care use. For example, Neumark et al. identified economic status as the determining factor for the number of visits to medical facilities (4). Inman et al. identified expenditure and time as the two most important constraints in using child health services (5). Other than financial considerations, severity and vulnerability of perceived disease are important triggers to initiate search for healthcare and may also influence the choice of health provider (6-8). Educational status could influence healthcare use, but studies have produced contradictory findings (9). For example, one study in Kerala, India, found a negative relationship between maternal education and care-seeking (10). In other settings, maternal education had a positive effect on healthcare use (4,11,12). The influence of gender of young patients on healthcare-seeking behaviour has been observed by many researchers in southern Asia (13). For example, gender was a significant predictor of treatment-seeking in Punjab (14). A study in Pune, Maharashtra state, found that significantly more boys than girls were treated by qualified healthcare professionals, significantly more money was spent on boys compared to girls, and parents were willing to travel a greater distance to have their sons treated compared to their daughters (15). Similarly, in Matlab, Bangladesh, physicians were consulted three times more often for male children (16). A recent study describing healthcare use of children aged less than five years in a rural community in West Bengal found that qualified health professionals were consulted more often and sooner for boys than for girls (17). Preferential treatment of sons becomes less marked from northern to southern India as the value of daughters increases (18).

In research studies, particularly for those that rely on passive surveillance, an understanding of healthcare use by the target population is crucial since differential healthcare-seeking behaviour could influence outcome. Active surveillance, that is visiting each individual or household in the target population at regular intervals to detect the disease episode of interest, could avoid this potential bias. However, for diarrhoeal disease research, an active surveillance may unnecessarily include trivial diarrhoea episodes. Furthermore, it may not be feasible to conduct an active surveillance for less-common outcomes, such as cholera, and an active surveillance for large populations is prohibitively expensive.

In preparation for a large surveillance project to estimate the disease burden of typhoid fever and cholera in an urban slum area in eastern Kolkata, we studied reported diarrhoea rates and factors associated with reported diarrhoea episodes. We also studied the local healthcare-use patterns and factors associated with the use of specific providers.


Study area

Kolkata, previously known as Calcutta, has an area of approximately 187 km2 and had a population of 4,580,544 in 2001. This congested urban area has an estimated population density of 24,760 persons per km2. Kolkata is divided into 141 administrative wards. In preparation for a cholera and typhoid fever surveillance project, a census and healthcare-use survey was conducted in a contiguous slum area encompassing most of Ward 29 and all of Ward 30 (Fig. 1). The results of the survey are presented in this report. …

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