Develay A, Sauerborn R, Diesfeld H J
Institut für Tropenhygiene und Offentliches Gesundheitswesen, Heidelberg, Germany.
Soc Sci Med. 1996 Dec;43(11):1611-9. doi: 10.1016/s0277-9536(96)00061-5.
This study analysed the level of utilization of different kinds of health care providers, and its correlates, by people reporting an illness via a household health survey in a representative sample of 547 households (3667 persons) in the city of Ouagadougou, Burkina-Faso in 1989. More than one-fourth of the sample reported suffering from a health care problem in the 2-week period preceding the interview. Self care was the most frequently reported type of care received (55.6%). Bivariate analysis and logistic regression revealed that the principal determinants of the utilization of modern care givers were age, socio-economic level, illness characteristics (type, length, severity), and cost of care and transportation. In particular, we found that: (1) Even though the family remained the main provider of care in case of minor (mild and short) illnesses, it did not prevent modern health facilities from playing their curative role in case of serious illnesses. (2) Residential zone (central versus peripheral zone) was not significantly associated with health care choice, which was contrary to expectation. (3) On the other hand, socio-economic status strongly affected health-seeking behavior. (4) The travel pattern of the ill persons favored health carde facilities in the central zone. Taken together, the results of this study question the role of community health workers in the urban program of community health care which was in the process of being implemented at the time of the study. They suggest that the family, instead of the community health workers, should be seen as the provider of curative care for minor illnesses. Community health workers may have a more effective role in health education than in curative tasks.
1989年，本研究通过对布基纳法索瓦加杜古市547户家庭（3667人）的代表性样本进行家庭健康调查，分析了报告患病的人群对不同类型医疗服务提供者的利用水平及其相关因素。超过四分之一的样本报告在访谈前两周内患有健康问题。自我护理是最常报告接受的护理类型（55.6%）。双变量分析和逻辑回归显示，使用现代护理提供者的主要决定因素是年龄、社会经济水平、疾病特征（类型、持续时间、严重程度）以及护理和交通成本。具体而言，我们发现：（1）尽管在患轻微（轻度和短期）疾病时，家庭仍然是主要的护理提供者，但这并不妨碍现代医疗设施在患严重疾病时发挥治疗作用。（2）居住区域（中心区与周边区）与医疗选择没有显著关联，这与预期相反。（3）另一方面，社会经济地位强烈影响就医行为。（4）患病者的出行模式有利于中心区的医疗设施。综合来看，本研究结果对研究期间正在实施的城市社区医疗保健项目中社区卫生工作者的作用提出了质疑。它们表明，对于轻微疾病，应将家庭而非社区卫生工作者视为治疗护理的提供者。社区卫生工作者在健康教育方面可能比在治疗任务中发挥更有效的作用。
