Factors associated with symptom frequency and health seeking behaviour of the general population, Gampaha district -Sri Lanka

Abstract

Public outpatient department (OPD) visits are estimated to increase from 55 million in 2014 to 100 million in 2027. With the private sector handling a similar share, this will be an unsustainable burden to the healthcare system. High illness sensitivity of the population and increase in healthcare seeking associated with socio-demographic factors could be some of the reasons fbr increasing OPD visits. This study from the Gampaha district describes the symptom frequency, healthcare-seeking pattern, associated socio-demographic characteristics, factors associated with selection between public or private sectors and methods of sei-care practised by the study population. Using a community-based prospective study design, the data collection was done in Ragama(urban) and Mirigama(rural) areas fbr one month. Participant-held symptom diary combined with interviews were used to collect patient data. From Ragama and Mirigama, six midwife areas were randomly chosen. Clusters of 15-20 households were selected from 5-6 random locations in each area. The study population was 2046 individuals, majority females (n=l 127,55.1%) from 557 households. The majority were from Mirigama (rural) 1207(59%). Symptoms were reported by 1919(93.8%). Phlegm (7.0%), leg pain (6.6%) and cough (5.3%) were top symptoms. Adult males were less likely to have symptoms [p=0.016,OR=0.46,95%CI(0.244-0.865)]. Healthcare was sought by 924(45.1%) and the majority (n=763,37.3%) preferred the allopathic system. Urban children [p<0.001 ,OR=0.546,95%C1(0.389・0.767)], and adults [p=0.004,OR=0.663 95%CI(0.502-0.877)] were less Hkely to seek care than their rural counterparts. For OPD care, the majority preferred the private (n=515,25.2%) compared to the public sector (n=330,16.1%). Having a regular doctor increased health-seeking in the private sector in children [p<0.001,OR=5.86,95%CI(3.28-10.486)]. For adults, regular doctor [p<0.001 ,OR=4.105,95%CI(2.098-8.03 l)]and income [p=0.037,OR=5.177,95%CI (1.102-24.317)] increased private sector visits. Of the 47(2.3%) that needed in-ward care, 42 were admitted to public hospitals, of which 19 were to teaching hospitals. Only 4 were admitted to private institutions. Having a regular doctor reduced the admissions [p=0.08,OR=0.397 95%CI(0.201- 0.785)]. The majority practised Allopathic self-care methods. The study population had high symptom reporting and high healthcare-seeking behaviour which may explain the increasing trend of outpatient visits. The majority preferred private sector fbr outpatient care and having a regular doctor and income, increased private-sector visits. Public hospitals were the choice of the majority fbr admissions.