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

doi:10.1111/tmi.13926

Community-level incidence and treatment seeking during febrile illness: Insights from health behaviour surveys in rural Thailand and Laos

Trop Med Int Health. 2023 Oct;28(10):806-816. doi: 10.1111/tmi.13926. Epub 2023 Aug 21.

Authors

Marco J Haenssgen¹, Nutcha Charoenboon², Annabelle Early³, Thomas Althaus^{4

5}

Affiliations

¹ Department of Social Science and Development, Chiang Mai University, Chiang Mai, Thailand.
² Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
³ Global Sustainable Development, School of Cross-Faculty Studies, University of Warwick, Coventry, UK.
⁴ Centre Scientifique de Monaco, Monaco, Monaco.
⁵ Direction de l'Action Sanitaire, Monaco, Monaco.

PMID: 37605295
DOI: 10.1111/tmi.13926

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.

Keywords: Lao PDR; Thailand; antibiotic use; community survey; fever; health behaviour.

Abstract

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