Wednesday, October 3, 2012

Survey on The Health Care Facilities Utilization for Influenza Like Illness in Two Sub-District Communities, Bandung District, West Java, Indonesia (1)

Project Summary

Influenza A/H5N1 is posing a continuous threat of global pandemic due to its' high fatality rate. For early detection and treatment, health seeking behavior in the community is become very important to reduce the morbidity and mortality. From year 2008 – 2010 we conducted a surveillance study in community health care center in two sub-districts communities, Bandung, Indonesia. Using Geographical Information System, our preliminary analysis demonstrated that in some area people were less likely utilized health care for Influenza Like Illness (ILI). Therefore we propose a study to explore factors that associated with health care facilities utilization for ILI in the area using behavioral, epidemiologic, and geographic methodologies. The hypothesis is that the health care utilization for ILI is associated with knowledge, ILI severity perception, and perceive of puskesmas’s quality of care, and this association is modified by socio-economic status and geographical accessibility. For that aim, we will select subjects by stratified random sampling and conduct home visit interview. Model for health care utilization attitude and practice will be developed by linear and logistic regression. Geographical distribution of the patients will be visualized in maps.  

Project Description (Scientific view)


Transmission of Highly Pathogenic Avian Influenza (HPAI) viruses from birds to human has resulted in over 598 infections with 352 fatalities globally1, with Indonesia being at the epicenter of this phenomenon, a posing a serious threat of a global pandemic. In this context, care seeking behavior, in the area where humans interact with backyard poultry and birds such as in Indonesia, has become one of the crucial issues for reducing morbidity and mortality, by early detection and treatment. 
For this reason, and to determine the extent of avian to human transmission of HPAI, between 2008 to 2011, we conducted a passive surveillance study of Influenza Like Illness in community primary health care centers (Puskesmas),in two sub-districts community, in Bandung District, West Java, Indonesia(total population about 212,000)2. Using Geographical Information Systems, we geocoded all houses of all residents in the catchment area, and of all patients who sought care at the Puskesmas in both areas over 3 years. Based on our preliminary analysis, it can be seen that in some areas (red circle), people were less likely to seek care and this was not explained merely by geographical proximity to the Puskesmas (Figure 1). 

Previous studies have shown that age, sex, socioeconomic status and perceived severity of illness influence health care seeking behavior3-5. A study in Nigeria showed that for childhood illnesses, most caretakers sought care within the home6. A nationwide study in Indonesia illustrated that low household income was a barrier to health care utilization, even when health care was free7. Finally perceived poor quality of healthcare  service was also associated with lower utilization of primary health care services8. Thus health care utilization is a multidimensional concept that is related to the characteristics of the population, their behavior, and the environment where they live9.  While some of the determinants such as age, sex, and socioeconomic are not amenable to change, there are factors that amenable to interventions, such as knowledge, perceived severity of influenza like illness, and quality of service delivery.  A study that can inform public health authorities on the magnitude of these factors affecting care seeking behavior of the people, help in designing an effective program to improve health care delivery. Based on these observations, our preliminary study and the pre-existing geo-mapping of 2 entire sub-districts, I propose to study the  health care utilization behavior for ILI in this well defined community, incorporating social, behavioral, epidemiologic and geographic methodologies.  

The objective of this study is to explore factors that are associated with community health care facilities (puskesmas) utilization for ILI in the two sub-district communities in Bandung, West Java, Indonesia. The hypothesis is that puskesmas utilization for ILI is associated with perceived severity of illness and perceived quality of care at the puskesmas. The effects of socioeconomic status and geographical accessibility, on these modifiable behaviors will be studied. 

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