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危地马拉农村地区急性呼吸道感染和腹泻的治疗选择。

Choices about treatment for ARI and diarrhea in rural Guatemala.

作者信息

Goldman Noreen, Pebley Anne R, Gragnolati Michele

机构信息

Office of Population Research, Princeton University, Wallace Hall, Princeton, NJ 08540, USA.

出版信息

Soc Sci Med. 2002 Nov;55(10):1693-712. doi: 10.1016/s0277-9536(01)00260-x.

Abstract

This paper uses the 1995 Guatemalan Survey of Family Health (EGSF) to analyze the relationship between child illness and health seeking behavior. The EGSF contains detailed calendar data on the nature and timing of illness and treatment behavior for children age five and below; extensive information about the characteristics of mothers, families and communities; and data on the accessibility of traditional and biomedical providers within and near the community. The analysis is based on 870 children who began a diarrheal or respiratory illness during a 2-week period prior to interview. Estimates are derived from a multinomial logit model of the probability of seeing a specific type of provider on a given day of illness, as a function of characteristics of the illness, child, mother, and community. The results indicate that modern medical care plays a major role in the treatment of infectious illness among children in rural Guatemala. The symptoms associated with the illness, their perceived severity, and mother's beliefs about their causes are important determinants of whether a child is brought to a provider and the type of provider visited. Poverty is a serious constraint on a family's choices about how to treat children's illnesses, whereas education and ethnicity have little effect on treatment behavior when income is held constant. In addition, the availability of modern health facilities within the community-both government-sponsored facilities and private doctors-has a substantial impact on the type of providers sought to treat children's illnesses.

摘要

本文利用1995年危地马拉家庭健康调查(EGSF)来分析儿童疾病与就医行为之间的关系。EGSF包含了五岁及以下儿童疾病性质和发病时间以及治疗行为的详细日历数据;关于母亲、家庭和社区特征的广泛信息;以及社区内和附近传统医疗服务提供者和生物医学服务提供者可及性的数据。该分析基于在访谈前两周内开始患腹泻或呼吸道疾病的870名儿童。估计值来自一个多项logit模型,该模型将患病某一天去看特定类型医疗服务提供者的概率作为疾病、儿童、母亲和社区特征的函数。结果表明,现代医疗护理在危地马拉农村地区儿童传染病治疗中发挥着主要作用。与疾病相关的症状、对其严重程度的认知以及母亲对病因的看法是决定是否带孩子去看医疗服务提供者以及去看何种类型医疗服务提供者的重要因素。贫困严重限制了家庭对如何治疗儿童疾病的选择,而在收入不变的情况下,教育程度和种族对治疗行为影响不大。此外,社区内现代卫生设施(包括政府资助的设施和私人医生)的可及性对寻求治疗儿童疾病的医疗服务提供者类型有重大影响。

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