Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand
Background The social determinants of health are a decisive yet persistently understudied area for tackling global health challenges like antimicrobial resistance (AMR). Precarity is one determinant whose importance is increasingly recognised, which we define here as ‘a form of pernicious self-depen...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-12-01
|
| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/12/e003779.full |
| _version_ | 1818569816951226368 |
|---|---|
| author | Marco J Haenssgen Nutcha Charoenboon Thipphaphone Xayavong Thomas Althaus |
| author_facet | Marco J Haenssgen Nutcha Charoenboon Thipphaphone Xayavong Thomas Althaus |
| author_sort | Marco J Haenssgen |
| collection | DOAJ |
| description | Background The social determinants of health are a decisive yet persistently understudied area for tackling global health challenges like antimicrobial resistance (AMR). Precarity is one determinant whose importance is increasingly recognised, which we define here as ‘a form of pernicious self-dependence that undermines individuals’ control over their own lives and limits their ability to flexibly respond to crises’. We aimed to assess the relationship between precarity, other forms of deprivation and healthcare-seeking behaviour by asking, ‘What is the impact of precarity, marginalisation and clinical presentation on healthcare-seeking behaviour?’ and ‘Do patients experiencing precarious livelihoods have clinically less advisable healthcare-seeking behaviour?’Methods We used healthcare-seeking behaviour census survey data from rural Thailand and Laos, wherein five rural communities were surveyed two times over a period of 3 months (2-month recall period). Using descriptive statistical and multivariate logistic regression analysis on the illness level, we studied precarity alongside clinical presentation, marginalisation and facilitating solutions during an illness (eg, health-related phone use) as determinants of healthcare-seeking behaviour in the form of healthcare access and antibiotic use.Results The data included 1421 illness episodes from 2066 villagers. Patients in precarious circumstances were up to 44.9 percentage points more likely to misuse antibiotics in the presence of situational facilitators (predicted antibiotic misuse: 6.2% (95% CI: 0.9% to 11.4%) vs 51.1% (95% CI: 16.6% to 85.5%) for precarious circumstances with/without facilitation). Marginalisation was linked to lower antibiotic use, but this did not translate into clinically more advisable behaviour. Clinical presentation played only a minor role in determining healthcare access and antibiotic use.Conclusions This study underlines the importance of context and local livelihoods in tackling drug resistance. While supporting the growing emphasis on AMR-sensitive development policy, we call for future research to study systematically the healthcare-seeking behaviour impact of precarious livelihoods, social policy and community development initiatives.Trial registration number NCT03241316. |
| first_indexed | 2024-12-14T06:52:40Z |
| format | Article |
| id | doaj.art-ec7baca93dee4cfe8ccde308df590096 |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-12-14T06:52:40Z |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-ec7baca93dee4cfe8ccde308df5900962022-12-21T23:12:51ZengBMJ Publishing GroupBMJ Global Health2059-79082020-12-0151210.1136/bmjgh-2020-003779Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and ThailandMarco J Haenssgen0Nutcha Charoenboon1Thipphaphone Xayavong2Thomas Althaus3Global Sustainable Development, University of Warwick, Coventry, West Midlands, UKPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UKJacobs, Cordova & Associates, Vientiane, Vientiane Capital, Lao People's Democratic RepublicCentre for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UKBackground The social determinants of health are a decisive yet persistently understudied area for tackling global health challenges like antimicrobial resistance (AMR). Precarity is one determinant whose importance is increasingly recognised, which we define here as ‘a form of pernicious self-dependence that undermines individuals’ control over their own lives and limits their ability to flexibly respond to crises’. We aimed to assess the relationship between precarity, other forms of deprivation and healthcare-seeking behaviour by asking, ‘What is the impact of precarity, marginalisation and clinical presentation on healthcare-seeking behaviour?’ and ‘Do patients experiencing precarious livelihoods have clinically less advisable healthcare-seeking behaviour?’Methods We used healthcare-seeking behaviour census survey data from rural Thailand and Laos, wherein five rural communities were surveyed two times over a period of 3 months (2-month recall period). Using descriptive statistical and multivariate logistic regression analysis on the illness level, we studied precarity alongside clinical presentation, marginalisation and facilitating solutions during an illness (eg, health-related phone use) as determinants of healthcare-seeking behaviour in the form of healthcare access and antibiotic use.Results The data included 1421 illness episodes from 2066 villagers. Patients in precarious circumstances were up to 44.9 percentage points more likely to misuse antibiotics in the presence of situational facilitators (predicted antibiotic misuse: 6.2% (95% CI: 0.9% to 11.4%) vs 51.1% (95% CI: 16.6% to 85.5%) for precarious circumstances with/without facilitation). Marginalisation was linked to lower antibiotic use, but this did not translate into clinically more advisable behaviour. Clinical presentation played only a minor role in determining healthcare access and antibiotic use.Conclusions This study underlines the importance of context and local livelihoods in tackling drug resistance. While supporting the growing emphasis on AMR-sensitive development policy, we call for future research to study systematically the healthcare-seeking behaviour impact of precarious livelihoods, social policy and community development initiatives.Trial registration number NCT03241316.https://gh.bmj.com/content/5/12/e003779.full |
| spellingShingle | Marco J Haenssgen Nutcha Charoenboon Thipphaphone Xayavong Thomas Althaus Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand BMJ Global Health |
| title | Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand |
| title_full | Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand |
| title_fullStr | Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand |
| title_full_unstemmed | Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand |
| title_short | Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand |
| title_sort | precarity and clinical determinants of healthcare seeking behaviour and antibiotic use in rural laos and thailand |
| url | https://gh.bmj.com/content/5/12/e003779.full |
| work_keys_str_mv | AT marcojhaenssgen precarityandclinicaldeterminantsofhealthcareseekingbehaviourandantibioticuseinrurallaosandthailand AT nutchacharoenboon precarityandclinicaldeterminantsofhealthcareseekingbehaviourandantibioticuseinrurallaosandthailand AT thipphaphonexayavong precarityandclinicaldeterminantsofhealthcareseekingbehaviourandantibioticuseinrurallaosandthailand AT thomasalthaus precarityandclinicaldeterminantsofhealthcareseekingbehaviourandantibioticuseinrurallaosandthailand |