Negatou Mariamawit, Ouedraogo Mady, Donnen Philippe, Paul Elisabeth, Samadoulougou Sekou, Kirakoya-Samadoulougou Fati
Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, École de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique.
Institut National de la Statistique et de la Démographie (INSD), Ouagadougou, Burkina Faso.
Risk Manag Healthc Policy. 2021 May 19;14:2065-2077. doi: 10.2147/RMHP.S297983. eCollection 2021.
In 2016, a free healthcare policy (FHP) was implemented in Burkina Faso for children under the age of five. In our study, we aimed to determine the prevalence of care-seeking for a fever in children under the age of five before and after the implementation of the FHP and to analyze the determinants of not seeking care under the FHP.
The data of three nationally representative surveys were used to evaluate the trends of the prevalence of care-seeking. We performed a modified Poisson regression using a generalized estimating equation to determine the factors associated with not seeking care.
The prevalence for care seeking increased from 57.5% (95% CI, 54.2-60.8) in 2014 to 72.3% (95% CI, 68.1-76.2) in 2017. Children from the poor quintile were less likely to seek care when compared to children from the poorest quintile (prevalence ratio (PR) = 0.7 (95% CI, 0.5-0.9)). Caregivers who did not have messages regarding malaria in the past six months were more likely not to seek care (PR = 0.8 (95% CI, 0.7-0.9)). Caregivers of children aged 36-59 months were more likely not to seek care compared to those aged <12 months (PR = 1.6 (95% CI, 1.2-2.1)). Children from the Boucle du Mouhoun region (PR = 1.9 (95% CI, 1.2-3.2)) and the Centre-Est region (PR = 1.9 (95% CI, 1.2-3.0)) were more likely not to seek care compared to children from the Sud Ouest region.
Our study showed an increase in the prevalence of care-seeking after the implementation of the FHP. Even if this is encouraging, these findings highlight the critical importance of non-financial barriers to care-seeking. Maintaining FHP and tackling the barriers should be considered by policy makers to increase care-seeking.
2016年，布基纳法索针对五岁以下儿童实施了免费医疗政策（FHP）。在我们的研究中，我们旨在确定FHP实施前后五岁以下儿童因发烧而寻求治疗的比例，并分析FHP下不寻求治疗的决定因素。
使用三项具有全国代表性的调查数据来评估寻求治疗比例的趋势。我们使用广义估计方程进行修正泊松回归，以确定与不寻求治疗相关的因素。
寻求治疗的比例从2014年的57.5%（95%CI，54.2 - 60.8）增至2017年的72.3%（95%CI，68.1 - 76.2）。与最贫困五分位组的儿童相比，贫困五分位组的儿童寻求治疗的可能性较小（患病率比（PR）= 0.7（95%CI，0.5 - 0.9））。在过去六个月中未收到疟疾相关信息的照料者更有可能不寻求治疗（PR = 0.8（95%CI，0.7 - 0.9））。与12个月以下儿童的照料者相比，36 - 59个月儿童的照料者更有可能不寻求治疗（PR = 1.6（95%CI，1.2 - 2.1））。与西南地区的儿童相比，穆洪河环形地区（PR = 1.9（95%CI，1.2 - 3.2））和中东部地区（PR = 1.9（95%CI，1.2 - 3.0））的儿童更有可能不寻求治疗。
我们的研究表明，FHP实施后寻求治疗的比例有所增加。即便这令人鼓舞，但这些发现凸显了寻求治疗的非财务障碍的至关重要性。政策制定者应考虑维持FHP并消除这些障碍，以增加寻求治疗的比例。
