Academic journal article Journal of Health Population and Nutrition

Preferences for Treatment of Diarrhoea and Dysentery in Kaengkhoi District, Saraburi Province, Thailand

Academic journal article Journal of Health Population and Nutrition

Preferences for Treatment of Diarrhoea and Dysentery in Kaengkhoi District, Saraburi Province, Thailand

Article excerpt

INTRODUCTION

An understanding of preferences of patients for treatment is useful in various biomedical studies. One example is surveillance studies that depend on passive health facility-based surveillance. Passive surveillance makes use of the existing healthcare structures and detects episodes of diarrhoea which lead the patient or caretaker to a request for treatment. In contrast, during active community-based surveillance, each eligible individual in the catchment population is asked at daily or weekly intervals whether he or she had diarrhoea during the preceding interval. Rates of diarrhoea estimated through active surveillance tend to be higher than rates detected by passive surveillance, since many episodes of diarrhoea are not severe enough to require treatment or are treated outside the surveillance system. A recent study in Viet Nam found that the rate of incidence of diarrhoea in children aged less than five years detected by active surveillance was about twice as high as the rate detected by passive surveillance (1). Once the percentage of disease episodes captured by passive surveillance has been estimated, a more accurate interpretation of incidence rates derived from such surveillance becomes feasible.

Knowledge about the patient's choice of provider is also essential background information for studies that measure the cost of illness. To compare the costs of a specific disease borne by the government with the costs of that disease borne by society as a whole, one has to know how many patients use governmental institutions and how many seek treatment from other healthcare providers, such as private practitioners, traditional healers, or private pharmacies. Finally, policy studies concerning the best allocation of resources for specific diseases require information about where patients seek care.

In preparation for large studies of diarrhoeal diseases due to Shigella in six Asian countries, the International Vaccine Institute has developed a rapid community-based survey to estimate the proportion of diarrhoea and dysentery patients in the catchment area who could be missed by passive surveillance. The rapid survey was tested in Kaengkhoi district, Saraburi province, Thailand, in conjunction with a three-year passive surveillance study for shigellosis which is based on a previously-published generic protocol (2). We carried out the community-based survey to estimate preferences of patients for treatment of diarrhoea and dysentery in the catchment area of the passive surveillance study.

MATERIALS AND METHODS

Study population

The catchment area for the shigellosis surveillance study is located in Kaengkhoi district, Saraburi province, Thailand, approximately 100 km north of Bangkok. The area includes a small city surrounded by rural villages that depend on agriculture for income. Data from the 2002 census maintained by government healthcare officers show a total population of 78,744 in the catchment area, including 5,006 (6.4%) children aged less than 60 months. The residents live in 19,786 households (mean household size 4 persons).

The healthcare system in Kaengkhoi district of Saraburi province has three tiers. The first contact with the healthcare system is the community health centre, a free-standing structure staffed by one or more nurse(s) who provide basic health services, stabilize emergency patients for transport elsewhere, and perform uncomplicated deliveries. The community health centre is not intended to admit patients overnight. There are 20 community health centres in the catchment area of the shigellosis surveillance study.

Patients who cannot be adequately cared for at the community health centre are transferred to the next, second level at the district hospital in Kaengkhoi, which is staffed by internists, paediatricians, and surgeons. Patients who require sub-specialty services or therapies not available in the district hospital are transferred to a third tier, the provincial hospital located near Kaengkhoi. …

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