Factors Influencing Care-Seeking Behavior Among Patients In Ethiopian Primary Health Care Units

Abstract Background The utilization of primary health care in many countries in sub-Saharan Africa has been limited. The objective of this study was to evaluate the factors that influenced why patients sought care at health centers versus primary hospitals in the primary health care unit (PHCU) in three regions in Ethiopia. The study also examined whether these factors varied based on a patient’s clinical or demographic characteristics and by whether they had sought prior care. Methods and Findings We conducted a cross-sectional study using face-to-face interviews in the local language with 796 people (99% response rate) seeking outpatient care in three primary health care units. We used unadjusted chi-square tests to detect significant differences between the hospital and health center samples on factors that influenced care-seeking behavior. The frequency of the self-reported factors differed significantly by health facility. Among those at the health center, the top four self-reported factors were distance (47.4%), quality of services (23.3%), previous positive experience (20.1%), and comfort or familiarity (12.4%). Among those at the hospital, the top four self-reported factors were quality of services (31.6%), distance (16.0%), no improvement after first visit to a health facility (15.3%), and level of health providers (14.8%). Those who bypassed lower levels of health care cited quality of services, level of health providers, and previous positive experience as significant reasons for seeking care directly at the hospital Conclusion This study found that there are significant differences in the reasons why patients utilize health centers versus primary hospitals, which highlights the need for tailored reforms based on the community’s perceived strengths and weaknesses of different primary care delivery sites

COVID-19 in humanitarian settings: documenting and sharing context-specific programmatic experiences.

Humanitarian organizations have developed innovative and context specific interventions in response to the COVID-19 pandemic as guidance has been normative in nature and most are not humanitarian specific. In April 2020, three universities developed a COVID-19 humanitarian-specific website ( www.covid19humanitarian.com ) to allow humanitarians from the field to upload their experiences or be interviewed by academics to share their creative responses adapted to their specific country challenges in a standardised manner. These field experiences are reviewed by the three universities together with various guidance documents and uploaded to the website using an operational framework. The website currently hosts 135 guidance documents developed by 65 different organizations, and 65 field experiences shared by 29 organizations from 27 countries covering 38 thematic areas. Examples of challenges and innovative solutions from humanitarian settings are provided for triage and sexual and gender-based violence. Offering open access resources on a neutral platform by academics can provide a space for constructive dialogue among humanitarians at the country, regional and global levels, allowing humanitarian actors at the country level to have a strong and central voice. We believe that this neutral and openly accessible platform can serve as an example for future large-scale emergencies and epidemics

A Patient-Centered Understanding of the Referral System in Ethiopian Primary Health Care Units.

Primary healthcare systems in sub-Saharan Africa have undergone substantial development in an effort to expand access to appropriate facilities through a well-functioning referral system. The objective of this study was to evaluate the current patterns of seeking prior care before arriving at a health center or a hospital as a key aspect of the referral system of the primary health care unit (PHCU) in three regions in Ethiopia. We examined what percentage of patients had either sought prior care or had been referred to the present facility and identified demographic and clinical factors associated with having sought prior care or having been referred.We conducted a cross-sectional study using face-to-face interviews in the local language with 796 people (99% response rate) seeking outpatient care in three primary health care units serving approximately 100,000 people each and reflecting regional and ethnic diversity; 53% (N = 418) of the sample was seeking care at hospital outpatient departments, and 47% of the sample was seeking care at health centers (N = 378). We used unadjusted and adjusted logistic regression to identify factors associated with having been referred or sought prior care. Our findings indicated that only 10% of all patients interviewed had been referred to their current place of care. Among those in the hospital population, 14% had been referred; among those in the health center population, only 6% had been referred. Of those who had been referred to the hospital, most (74%) had been referred by a health center. Among those who were referred to the health center, the plurality portion (32%) came from a nearby hospital (most commonly for continued HIV treatment or early childhood vaccinations); only 18% had come from a health post. Among patients who had not been formally referred, an additional 25% in the hospital sample and 10% in the health center sample had accessed some prior source of care for their present health concern. In the adjusted analysis, living a longer distance from the source of care and needing more specialized care were correlated with having sought prior care in the hospital sample. We found no factors significantly associated with having sought prior care in the health center sample.The referral system among health facilities in Ethiopia is used by a minority of patients, suggesting that intended connections between health posts, health centers, and hospitals may need strengthening to increase the efficiency of primary care nationally

Descriptive statistics by type of facility.

<p>¹ 43 people did not report their age.</p><p>² 164 people did not know the distance</p><p>³ P-Values calculated using chi-squared test for categorical variables and Student’s t-test for continuous variable age.</p><p>Descriptive statistics by type of facility.</p

Sources of prior care and sources of referrals.

<p>¹ HEW: Health extension worker</p><p>² PHCU: Primary health care unit</p><p>³ Other includes follow up, non-governmental organizations, Emmanuel Mental Health hospital, care abroad, and traditional medicine.</p><p>⁴ N = 13 people seeking care at a hospital had sought care at more than 1 prior facility, and N = 3 people seeking care at a health center had sought care at more than 1 prior facility.</p><p>Sources of prior care and sources of referrals.</p

Categorization of Chief Complaint.

<p>Categorization of Chief Complaint.</p

Factors associated with being referred from prior source of care.

<p>CI: Confidence interval</p><p>*P-Value < 0.05</p><p>Factors associated with being referred from prior source of care.</p

The potential impact of COVID-19 in refugee camps in Bangladesh and beyond: A modeling study.

BackgroundCOVID-19 could have even more dire consequences in refugees camps than in general populations. Bangladesh has confirmed COVID-19 cases and hosts almost 1 million Rohingya refugees from Myanmar, with 600,000 concentrated in the Kutupalong-Balukhali Expansion Site (mean age, 21 years; standard deviation [SD], 18 years; 52% female). Projections of the potential COVID-19 burden, epidemic speed, and healthcare needs in such settings are critical for preparedness planning.Methods and findingsTo explore the potential impact of the introduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Kutupalong-Balukhali Expansion Site, we used a stochastic Susceptible Exposed Infectious Recovered (SEIR) transmission model with parameters derived from emerging literature and age as the primary determinant of infection severity. We considered three scenarios with different assumptions about the transmission potential of SARS-CoV-2. From the simulated infections, we estimated hospitalizations, deaths, and healthcare needs expected, age-adjusted for the Kutupalong-Balukhali Expansion Site age distribution. Our findings suggest that a large-scale outbreak is likely after a single introduction of the virus into the camp, with 61%-92% of simulations leading to at least 1,000 people infected across scenarios. On average, in the first 30 days of the outbreak, we expect 18 (95% prediction interval [PI], 2-65), 54 (95% PI, 3-223), and 370 (95% PI, 4-1,850) people infected in the low, moderate, and high transmission scenarios, respectively. These reach 421,500 (95% PI, 376,300-463,500), 546,800 (95% PI, 499,300-567,000), and 589,800 (95% PI, 578,800-595,600) people infected in 12 months, respectively. Hospitalization needs exceeded the existing hospitalization capacity of 340 beds after 55-136 days, between the low and high transmission scenarios. We estimate 2,040 (95% PI, 1,660-2,500), 2,650 (95% PI, 2,030-3,380), and 2,880 (95% PI, 2,090-3,830) deaths in the low, moderate, and high transmission scenarios, respectively. Due to limited data at the time of analyses, we assumed that age was the primary determinant of infection severity and hospitalization. We expect that comorbidities, limited hospitalization, and intensive care capacity may increase this risk; thus, we may be underestimating the potential burden.ConclusionsOur findings suggest that a COVID-19 epidemic in a refugee settlement may have profound consequences, requiring large increases in healthcare capacity and infrastructure that may exceed what is currently feasible in these settings. Detailed and realistic planning for the worst case in Kutupalong-Balukhali and all refugee camps worldwide must begin now. Plans should consider novel and radical strategies to reduce infectious contacts and fill health worker gaps while recognizing that refugees may not have access to national health systems