Perceived Morbidity, Healthcare-Seeking Behavior and Their Determinants in a Poor-Resource Setting: Observation from India

BACKGROUND: To control the double burden of communicable and non-communicable diseases (NCDs), in the developing world, understanding the patterns of morbidity and healthcare-seeking is critical. The objective of this cross-sectional study was to determine the distribution, predictors and inter-relationship of perceived morbidity and related healthcare-seeking behavior in a poor-resource setting. METHODS: Between October 2013 and July 2014, 43999 consenting subjects were recruited from 10107 households in Malda district of West Bengal state in India, through multistage random sampling, using probability proportional-to-size. Information on socio-demographics, behaviors, recent ailments, perceived severity and healthcare-seeking were analyzed in SAS-9.3.2. RESULTS: Recent illnesses were reported by 55.91% (n=24600) participants. Among diagnosed ailments (n=23626), 50.92% (n=12031) were NCDs. Respiratory (17.28%,n=7605)), gastrointestinal (13.48%,n=5929) and musculoskeletal (6.25%,n=2749) problems were predominant. Non-qualified practitioners treated 53.16% (n=13074) episodes. Older children/adolescents [adjusted odds ratio for private healthcare providers(AOR(Pri))=0.76, 95% confidence interval=0.71-0.83) and for Govt. healthcare provider(AOR(Govt))=0.80(0.68-0.95)], females [AOR(Govt)=0.80(0.73-0.88)], Muslims [AOR(Pri)=0.85(0.69-0.76) and AOR(Govt=)0.92(0.87-0.96)], backward castes [AOR(Govt)=0.93(0.91-0.96)] and rural residents [AOR(Pri)=0.82(0.75-0.89) and AOR(Govt)=0.72(0.64-0.81)] had lower odds of visiting qualified practitioners. Apparently less severe NCDs [acid-peptic disorders: AOR(Pri)=0.41(0.37-0.46) & AOR(Govt)=0.41(0.37-0.46), osteoarthritis: AOR(Pri)=0.72(0.59-0.68) & AOR(Govt)=0.58(0.43-0.78)], gastrointestinal [AOR(Pri)=0.28(0.24-0.33) & AOR(Govt)=0.69(0.58-0.81)], respiratory [AOR(Pri)=0.35(0.32-0.39) & AOR(Govt)=0.46(0.41-0.52)] and skin infections [AOR(Pri)=0.65(0.55-0.77)] were also less often treated by qualified practitioners. Better education [AOR(Pri)=1.91(1.65-2.22) for ≥graduation], sanitation [AOR(Pri)=1.58(1.42-1.75)] and access to safe water [AOR(Pri)=1.33(1.05-1.67)] were associated with healthcare-seeking from qualified private practitioners. Longstanding NCDs [chronic obstructive pulmonary diseases: AOR(Pri)=1.80(1.46-2.23), hypertension: AOR(Pri)=1.94(1.60-2.36), diabetes: AOR(Pri)=4.94(3.55-6.87)] and serious infections [typhoid: AOR(Pri)=2.86(2.04-4.03)] were also more commonly treated by qualified private practitioners. Potential limitations included temporal ambiguity, reverse causation, generalizability issues and misclassification. CONCLUSION: In this poor-resource setting with high morbidity, ailments and their perceived severity were important predictors for healthcare-seeking. Interventions to improve awareness and healthcare-seeking among under-privileged and vulnerable population with efforts to improve the knowledge and practice of non-qualified practitioners probably required urgently.