利用安德森医疗保健利用模型评估九个中低收入国家成年人 COVID-19 检测相关因素：一项在线调查。
Using Andersen's model of health care utilization to assess factors associated with COVID-19 testing among adults in nine low-and middle-income countries: an online survey.
机构信息
Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, 10400, Thailand.
Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa.
出版信息
BMC Health Serv Res. 2022 Feb 28;22(1):265. doi: 10.1186/s12913-022-07661-8.
BACKGROUND
This study aimed to investigate, using Andersen's model of health care utilization, factors associated with COVID-19 testing among adults in nine low- and middle- income countries.
METHODS
In between 10 December 2020 and 9 February 2021, an online survey was organized in nine low- and middle-income countries. In total 10,183 adults (median age 45 years, interquartile range 33-57 years, range 18-93 years), including 6470 from Brazil, 1738 Malaysia, 1124 Thailand, 230 Bangladesh, 219 DR Congo, 159 Benin, 107 Uganda, 81 Malawi and 55 from Mali participated in the study. COVID-19 testing/infection status was assessed by self-report.
RESULTS
Of the 10,183 participants, 40.3% had ever tested for COVID-19, 7.3% tested positive, and 33.0% tested negative. In an adjusted logistic regression model, predisposing factors (residing in Brazil, postgraduate education), enabling/disabling factors (urban residence, higher perceived economic status, being a student or worker in the health care sector, and moderate or severe psychological distress), and need factors (having at least one chronic condition) increased the odds of COVID-19 testing. Among those who were tested, participants residing in Bangladesh, those who had moderate to severe psychological distress were positively associated with COVID-19 positive diagnosis. Participants who are residing in Malaysia and Thailand, and those who had higher education were negatively associated with a COVID-19 positive diagnosis. Considering all participants, higher perceived economic status, being a student or worker in the health sector, and moderate or severe psychological distress were positively associated with a COVID-19 positive diagnosis, and residing in Malaysia, Thailand or five African countries was negatively associated with a COVID-19 positive diagnosis.
CONCLUSION
A high rate of COVID-19 testing among adults was reported in nine low-and middle-income countries. However, access to testing needs to be increased in Africa. Moreover, COVID-19 testing programmes need to target persons of lower economic status and education level who are less tested but most at risk for COVID-19 infection.
背景
本研究旨在使用安德森医疗保健利用模型，调查九个中低收入国家成年人中与 COVID-19 检测相关的因素。
方法
在 2020 年 12 月 10 日至 2021 年 2 月 9 日期间，在九个中低收入国家组织了一项在线调查。共有 10183 名成年人（中位数年龄 45 岁，四分位距 33-57 岁，范围 18-93 岁）参与了这项研究，其中包括来自巴西的 6470 人，马来西亚的 1738 人，泰国的 1124 人，孟加拉国的 230 人，刚果民主共和国的 219 人，贝宁的 159 人，乌干达的 107 人，马拉维的 81 人，马里的 55 人。COVID-19 检测/感染状况通过自我报告进行评估。
结果
在 10183 名参与者中，40.3%曾接受过 COVID-19 检测，7.3%检测呈阳性，33.0%检测呈阴性。在调整后的逻辑回归模型中，倾向因素（居住在巴西，研究生教育）、促成因素/阻碍因素（城市居住，较高的经济感知状况，在医疗保健部门工作的学生或工人，以及中度或重度心理困扰）和需要因素（至少有一种慢性疾病）增加了 COVID-19 检测的可能性。在接受检测的人群中，居住在孟加拉国的参与者和有中度至重度心理困扰的参与者与 COVID-19 阳性诊断呈正相关。居住在马来西亚和泰国的参与者以及接受过高等教育的参与者与 COVID-19 阳性诊断呈负相关。考虑到所有参与者，较高的经济感知状况，在医疗保健部门工作的学生或工人，以及中度或重度心理困扰与 COVID-19 阳性诊断呈正相关，而居住在马来西亚、泰国或五个非洲国家与 COVID-19 阳性诊断呈负相关。
结论
报告了九个中低收入国家成年人中 COVID-19 检测率较高。然而，需要增加非洲的检测机会。此外，COVID-19 检测计划需要针对经济地位和教育水平较低、检测次数较少但感染 COVID-19 风险较高的人群。
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