Care seeing behaviour in acute febrile illness 2
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This dissertation presentation examines the care-seeking behavior of Burmese migrants with acute febrile illness on the Thai-Burma border. The presentation includes a literature review on care-seeking behavior in acute febrile illness among Burmese migrants and other Asian populations. It also analyzes an existing dataset of 322 interviews with inpatients from clinics on the border to describe their care-seeking journeys and identify factors associated with the time taken to reach care.
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Care seeing behaviour in acute febrile illness 2
- 1. Supervisor: Prof T Hesketh Care-seeking behaviour in acute febrile illness Dissertation presentation – literature review and analysis of an existing data set
- 2. Dissertation presentation: Overview ✤ Topic: Care-seeking behaviour of Burmese migrants with severe febrile illness presenting to clinics on the Thai-Burma border ✤ Background and objectives ✤ Part 1 - literature review ✤ Methodology ✤ Themes ✤ Part 2 - data analysis ✤ The data ✤ Methodology
- 3. Background ✤ Burmese army fighting indigenous groups ✤ Refugees cross Thai-Burma border ✤ 200,000 refugees outside camps, 150,000 in camps ✤ Shoklo Malaria Research Unit ✤ 4 clinics for refugees and migrant workers
- 4. Dissertation Objectives ✤ I - To review the evidence relating to care-seeking behaviour of this Burmese migrant population and of other people in Asia in acute febrile illness ✤ II - To describe the care-seeking journey of Burmese migrants attending clinics on the Thai-Burma border in Tak Province in cases of severe febrile illness ✤ III - To identify associations between time taken to reach care and severity of illness / sociodemographic characteristics / symptoms
- 5. Part I - Literature review Questions ✤ What is known about the care-seeking behaviour of Burmese people living on the Thai-Burma border in acute febrile illness? ✤ What is known about the care-seeking behaviour of people in Asia, both migrants and non-migrants, in acute febrile illness?
- 6. Part I - Literature review Methodology ✤ Sources: Pubmed / Medline, Cochrane Library, JSTOR, Web of Knowledge, Google Scholar, Burma library ✤ Search terms 1: (“Thai-Burma border”) AND (“care- seeking” OR “access”). Articles screened for: relevance to acute febrile illness, populations outside refugee camps ✤ Search terms 2: (“care-seeking” AND “fever” OR “pneumonia” OR “malaria” OR “acute” OR “Asia”). Articles screened for: referring to Asia and acute febrile illness ✤ Five key themes
- 7. Part II - Data analysis The data ✤ 322 interviews with in-patients at 3 clinics ✤ Data: symptoms, duration, places care sought, why, barriers, costs ✤ Consultation with Tak Border Community Ethical Advisory Group ✤ Ethical approval: Oxford Tropical Research Ethics Committee ✤ Pre-testing, revision, consent ✤ Describe care-seeking journey ✤ Identify associations
- 8. Part II - Data analysis Methodology for analysis ✤ Summary of: ✤ Socio-demographic characteristics ✤ Symptoms of illness and duration ✤ Healthcare providers used, reasons for choices and reasons for delays ✤ Methods of transport used, cost and time to reach clinic ✤ Clinical diagnoses (and how these relate to symptoms) ✤ Further analysis: ✤ Flow charts of pathways to in- patient care ✤ Relationship between markers of severity and time taken to reach care (univariate analysis) ✤ Relationship between sociodemographic factors / symptoms of illness and time to care (multivariate analysis)
- 9. Summary ✤ Background ✤ Objectives ✤ Literature review ✤ The dataset ✤ Data analysis Thank you. Any questions?
- 10. References ✤ Ettling, M.B., Krongthing T, Somsak K, Pongwit B (1989) Malaria clinics in Mae sot, Thailand: factors affecting clinic attendance Southeast Asian J Trop Med Public Health, 20 (3): 331-340 ✤ Isarabhakdi Pimonpan (2004) Meeting at the Crossroads: Myanmar Migrants and Their Use of Thai Health Care Services Asian and Pacific Migration Journal, 13 (1):107-126. Available at http://www.whothailand.org/LinkFiles/Border_Health_Meeting_at_the_Crossroads_DrPimonphan.pdf. Last accessed 18/03/2012. ✤ Shoklo Malaria Research Unit (no date) Malaria Handbook, available at http://www.shoklo-unit.com/Handout/. Accessed 13/04/2012. ✤ Thailand Burma Border Consortium, 2012. Programme Report 2011 July to December. Available at http://www.tbbc.org/resources/resources.htm#reports. Accessed 11/04/2012. ✤ United Nations Statistics Division (2011) Composition of macro geographical (continental) regions. Available at http://unstats.un.org/unsd/methods/m49/m49regin.htm. Last accesed 30/05/2012. ✤ World Health Organisation (1991). Technical Basis for the WHO Recommendation on the Management of Pneumonia in Children at First-level Health Facilities. Available at http://www.who.int/maternal_child_adolescent/documents/ari_91_20/en/. Accessed 13/04/2012. ✤ World Health Organisation and UNICEF (2004) Joint Statement: management of pneumonia in community settings. Geneva / New York: WHO/UNICEF. Available at http://whqlibdoc.who.int/hq/2004/WHO_FCH_CAH_04.06.pdf. Last accessed 18/04/2012. ✤ World Health Organisation (2010). Accelerating Progress Towards the Millenium Development Goals. Available at http://www.who.int/topics/millennium_development_goals/MDG-NHPS_brochure_2010.pdf. Accessed 11/04/2012.
Editor's Notes
- Burma’s Eastern border with Thailand. violent conflict in Burma…Since WW2 and particularly since the 1970s the Burmese Army has been fighting against indiginous ethinc groups, such as the Karen and the Mon. In 1984 increasing violence pushed 10,000 refugees into Thailand without hope of return. Whilst initially predicted to be a short-term problem, the conflict has persisted and there are now 146,000 refugees in camps along the border and another 200,000 refugees outside the camps. Estimates suggest that at least a million people have been absorbed into the border area over the past 25 years. SMRU is academic unit designed to serve the local pop, in partic working on maternal morbidity from malaria. Part of Mahidol-Wellcome-Oxford research unit.
- II- using an existing data set Mention rationale – meeting MDGs 4 (child), 5 (maternal), 6 (HIV and other diseases esp 6c malaria) for this group, designing community-based treatments – need to understand current situation in order to improve it. Relevance also to other rural areas and migrant groups as well as to epidemiology of tropical diseases.
- 1. Living or working or attending for care Which symptoms prompt care-seeking? Where do people seek care and why do they chose certain places? What are the barriers to seeking care? 2. ASIA = EASTERN / SOUTHERN / SOUTH-EAST according to United Nations Statistical division geographical regions. NOT Western and Central.
- Mention mesh terms esp Thai-Burma border includes Thailand / Myanmar / border and non Inclusion criteria: primary research, reviews, full text available Mention that these searches give high sensitivity but low specificity so search will be completed manually Themes – symptom recognition and symptoms prompting care, choice of provider and reasons for choice, practical aspects eg. Distance to facility, barriers to accessing care eg. language, beliefs about illness and how these affect care-seeking
- I led study design and data collection data collection, then data entry, return to check data, cleaning – whole process 2009 -2011 Data collected to describe the care-seeking journey of Burmese migrants accessing clinics on the TBB and to ascertain associations between time to care and severity / symptoms / sociodemographic indicators Sociodemographic = number in household, employment, level of education, immigration status, income Inclusion criteria - Able to provide informed consent AND one of: temperature >37.5 on admission history of fever receiving antibiotic or antimalarial treatment suspected infective cause of illness Exclusion criteria - Either: Babies born in clinic who had not returned home since birth Mother with infective illness directly related to giving birth who had not returned home since delivery
- Very large data set – not yet written up. Several aspects to look at for analysis – for dissertation these particular elements have been selected and literature review will be conducted around these elements. All analysis in dissertation is within analysis specified in ethical approval. Since started work on dissertation, tabulations completed and initial Cox model but needs to be reviewed. Data also available on clinical signs on admission, lab results eg. Hb, parasitaemia Severity CI, t-test, ANOVA Eg. Is there a significant difference between the mean time taken to reach care and requiring Iv medication or not? Explain some of the forces – if obviously quicker then care sought quicker… We are not able to demonstrate causality – cannot say longer time to care causes greater severity, just associations. Cox Then, do particular symptoms prompt different patterns of care-seeking ie. Quicker or slower? Are particular sociodemographic caracteristics associated with quicker or slower access to care. This gives a hazard ratio where >1 = quicker access and <1 = slower access. USES – targetting barriers to care, for example, invest in CHWs? Improve services at shops? Education traditional healers? Educate re symptom recognition? Transferability? This is a specific population BUT there are very few studies of this size in any population detailing CSB. May help to inform future studies as well as interventions. Will be done in STATA
- RE primary / secondary – I was involved in data collection. However, not yet written up. This is a large existing data set with multiple possibilities for analysis, all with within scope of original ethical approval, and therefore for the dissertation this will function as secondary data analysis. The literature review will be conducted to support the elements of analysis conducted for the dissertation and will be completely new. The design and data collection parts of the study were much larger than could have been achieved in the time available for the dissertation.