Community‐level incidence and treatment seeking during febrile illness: Insights from health behaviour surveys in rural Thailand and Laos
Marco J. Haenssgen, Nutcha Charoenboon, Annabelle Early, Thomas Althaus- Infectious Diseases
- Public Health, Environmental and Occupational Health
- Parasitology
Abstract
Objective
Critical gaps remain in understanding community perceptions and treatment‐seeking behaviours in case of fever. This is especially relevant considering global antimicrobial resistance, where fever is assumed to provoke non‐judicious antibiotic use. Our study objective was therefore to document the community‐level incidence of fever, the resulting treatment‐seeking processes, and their underlying behavioural drivers.
Methods
In a cross‐sectional observational design, we used descriptive and inferential statistics and multivariable regression analysis to estimate the population‐level incidence of fever and individual and socio‐economic factors associated with treatment‐seeking process characteristics. We utilised a detailed publicly available survey of community‐level treatment‐seeking behaviour (collected in 2017/2018), comprising a representative sample of 2130 rural adults in Thailand (Chiang Rai Province) and Lao PDR (Salavan Province).
Results
Fever was reported by 7.1% of the rural adult population in Chiang Rai (95% CI: 5.1%–9.0%) and 7.5% in Salavan (95% CI: 4.5%–10.5%) during a 2‐month recall period. Treatment‐seeking patterns varied by socio‐economic characteristics like precarious employment. 69.3% (95% CI: 60.8%–77.7%) of fever episodes involved access to formal (public/private) healthcare providers, 11.0% (95% CI: 4.5%–17.5%) involved informal providers, and 24.3% (95% CI: 16.6%–32.1%) took place without either formal or informal healthcare access. Febrile patients had on average 0.39 antibiotic use episodes when accessing formal healthcare settings, compared to 0.05 otherwise (p < 0.01).
Conclusion
Treatment‐seeking behaviour during fever varies according to population characteristics. Clinical studies would benefit from contextualising quantitative outcomes. Treatment algorithms for non‐malarial febrile illnesses should involve outreach to informal healthcare and community settings to support patients in precarious circumstances, and antibiotic resistance interventions should prioritise formal healthcare facilities.