Duke University, School of Medicine, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya.
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
Public Health. 2014 Nov;128(11):993-1008. doi: 10.1016/j.puhe.2014.08.010. Epub 2014 Nov 18.
The impact of effective, life-saving health interventions is limited by access to and use of health services. Health seeking behaviour is likely to vary geographically and by type of health concern. However, little is known about the extent of this heterogeneity.
A representative cluster-randomized sample of households in four districts in western Kenya was interviewed using a structured, interviewer-administered survey. GPS coordinates of all households and all local health facilities were also collected.
Household surveys measured health seeking behaviour for three distinct health needs: family planning which is a form of prevention, delivery which is an urgent care need but can be planned in advance, and childhood febrile illness which is an unexpected and potentially life-threatening concern. Logistic regression models were used to explore the relationship between seeking health services and maternal and household characteristics, with special attention to geographic and financial access to care.
Use of health services for these three different health issues varied between the districts and also differed from national estimates. Place of delivery was most strongly correlated with the type of health services available to the family, whereas family planning was correlated with the relationship of the mother to the head of household. There was no strong interaction between socio-economic status and distance to services.
The level of services available nearest to households rather than the distance to travel influences treatment-seeking behaviour, particularly for urgent care. Maternal factors and household wealth were often important but, even within the same households, their effect changes based on the type of health concern. Generalizing from nationwide surveys may obscure important local heterogeneity, particularly in delivery location and fever treatment.
有效的、拯救生命的卫生干预措施的效果受到获取和利用卫生服务的限制。卫生服务寻求行为可能因地理位置和卫生问题的类型而异。然而，人们对这种异质性的程度知之甚少。
在肯尼亚西部的四个地区，采用代表性的整群随机抽样方法，对家庭进行了结构化的、由调查员管理的调查。还收集了所有家庭和所有当地卫生设施的 GPS 坐标。
家庭调查衡量了三种不同卫生需求的卫生服务寻求行为：计划生育是一种预防形式，分娩是一种紧急护理需求，但可以提前计划，儿童发热疾病是一种意外的、可能危及生命的担忧。使用逻辑回归模型探索寻求卫生服务与母婴和家庭特征之间的关系，特别关注地理和经济上的医疗服务获取。
对于这三种不同的健康问题，使用卫生服务的情况在不同地区有所不同，也与全国估计值不同。分娩地点与家庭可获得的服务类型最密切相关，而计划生育与母亲与家庭户主的关系相关。社会经济地位和服务距离之间没有强烈的相互作用。
家庭附近可获得的服务水平而不是旅行距离影响治疗寻求行为，特别是对紧急护理而言。母婴因素和家庭财富通常很重要，但即使在同一家庭中，它们的影响也会根据健康问题的类型而变化。从全国性调查中推断可能会掩盖重要的地方异质性，特别是在分娩地点和发热治疗方面。
