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Open Access 01-12-2022 | Cough | Research

Drivers of respiratory health care demand in Acre state, Brazilian Amazon: a cross-sectional study

Authors: Thiago Morello, Aldo Santos Lima, Rubicleis Gomes da Silva

Published in: BMC Public Health | Issue 1/2022

Abstract

Background

The scarce knowledge about the drivers of demand for respiratory health care in the Brazilian Amazon, where the gap of human and physical health care resources is wide, is expanded with two surveys conducted in the west of the region, in Acre state. Potential drivers, informed by a review of twelve recent papers, were classified into seven categories capturing the individual, household, community and macroeconomic dimensions.

Methods

Quantitative field surveys were conducted in 2017 and 2019 based on coupled conglomerate-quota randomization sampling. Adults responded about their own health or their children’s health. The probability of seeking physician care for the latest episode of respiratory illness or dry cough was analysed with multiple nonlinear regressions, having as covariates the potential predictors informed by the literature.

Results

The propensity to seek health care and to purchase medication was larger for children. Influenza-like illness (Despite the exact diagnostic stated by respondents being “influenza”, a virus detection test (such as the PCR test) is not commonly applied, as informed by the Acre state public health service. In consistency, the term “influenza-like illness” is used.) was the most frequently diagnosed disease, followed by pneumonia, suggesting that a health care-seeking rate below 40% may perpetuate health impairment and local contagion. Illnesses’ severity, including the pain experienced, was the main predictor, revealing that subjective perception was more influential than objective individual and household characteristics.

Conclusions

The results suggest that subjective underestimation of respiratory illnesses’ consequences for oneself and for local society could prevent health care from being sought. This is in line with some previous studies but departs from those emphasizing the role of objective factors. Social consequences, of, for instance, a macroeconomic nature, need to be highlighted based on studies detecting long-run relationships among health care demand, health and economic performance at the national level. Depending on the intensity of the trade-off between the costs imposed on the health system by increased demand and on the economy by the reduced productivity of the ill, policy could be adopted to change subjective perceptions of illnesses with nudges and educational and informational interventions.

Available only for authorised users

This estimate considers, from the nine Amazonian states, only the six belonging to the Brazilian Northern region.

Idem.

As stated in group interviews with CHAs conducted in Rio Branco and Cruzeiro do Sul in August and September 2019.

WTP was estimated as part of a broader research project about policy alternatives to reduce atmospheric pollution from agricultural fires (as detailed in [56]).

The help of three CHAs was sought in each neighbourhood, a number that was reduced in the few cases of small neighbourhoods.

In addition, CHAs’ presence ensured the safety of the undergraduate enumerators, since criminal activity was frequent in some localities according to CHAs and primary care staff.

For the reader interested in knowing which symptoms were inquired, the most recurrent among them are reported in Region of study below.

Other questions not used in this paper, for being out-of-scope or for being responded to by an insufficient number of participants, were Likert scales of agreement with four potential causes of the illness and, only in the case in which care was sought, the time waited in the health facility and missed days of work.

It is clarified that the cough survey was completed before confirmation of the first COVID-19 case in Acre state (the first case was detected on 19 March and the last interview occurred on 18 March). It was exactly because COVID-19 was starting to spread in southeastern Brazil (where the first author, who was legally responsible for the survey before the Brazilian Ethical Council, was based) that the survey was stopped, avoiding the exposure of enumerators (undergraduate students) and community health agents to risk.

Due to the COVID-19 pandemic, interviews were interrupted, resulting in a sample inferior to the planned level but still sufficient for econometric analysis.

Medication should lead to a more realistic and conservative estimate of WTP to avoid a respiratory illness than the prevention yielded by vaccination.

It also is related, in the literature, with the inhalation of fine particulate matter released by the combustion of biomass in general, and, in particular, by agricultural burnings ([60, 61]).

The intervals were: (0) zero income, (1) zero to half minimum wage (MW), (2) half MW to 1 MW, (3) 1 to 2 MWs, (4) 2 to 3 MWs, (5) 3 to 4 MWs, (6) 4 to 5 MWs, (7) 5 to 10 MWs, (8) > 10 MWs.

Lower income and higher poverty in the cough survey were due to the inclusion of the Cruzeiro do Sul municipality, where 54% of interviews occurred.

Duration and number of symptoms may be objectively measured but are here considered subjective for being directly related with the discomfort experienced.

In the health literacy scale used by Suka et al. (2016 and 2013), besides capacity to read and understand information, which are skills directly related with education, there also are less related components, such as proneness to seek information about disease and treatments and whether the credibility of obtained information is checked or not.

With the average per capita number of ambulatory plus hospital beds being 37% larger in Amazonian municipalities above 100,000 inhabitants by November 2021 [10, 15].

According to [59], “many patients do not seek medical attention” for cough, and [69], which claimed that “probably the majority of patients with cough, certainly acute cough, go to a pharmacy rather than a physician and therefore escape epidemiological surveys”.

It is helpful to describe the main differences between the surveys and the ambulatory records. The geographical reach of the former is broader, as it captures the whole state, including rural areas. It also tends to have more precise diagnosis information, as it is not based on patients’ memory, as it is in the case of the surveys, but rather on a compilation of physicians’ reports. Nevertheless, in the surveys, inhabitants were visited in their houses by interviewers, whereas it was their choice to visit a health unit and thus to be captured in the ambulatory dataset.

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Title: Drivers of respiratory health care demand in Acre state, Brazilian Amazon: a cross-sectional study
Authors: Thiago Morello
Aldo Santos Lima
Rubicleis Gomes da Silva
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Cough
Care
Cough
Cough
Published in: BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-022-14171-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Drivers of respiratory health care demand in Acre state, Brazilian Amazon: a cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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