title: Determinants of health-seeking behaviour for schistosomiasis-related symptoms in the context of integrating schistosomiasis control within the regular health services in Ghana.
abstract: Morbidity control of schistosomiasis through integration within existing health care delivery systems is considered a potentially sustainable and cost-effective approach. We conducted a questionnaire-based field study in a Ghanaian village endemic for both urinary and intestinal schistosomiasis to determine whether infected individuals self-reported to health centres or clinics and to identify factors that influenced their decision to seek health care. A total of 317 subjects were interviewed about having signs and symptoms suggestive of schistosomiasis: blood in urine, painful urination, blood in stool/bloody diarrhoea, abdominal pain, diarrhoea, swollen abdomen and fatigue within 1 month of the day of the interview. Fever (for malaria) was included as a disease of high debility for comparison. Around 70% with blood in urine or painful urination did not seek health care, whilst diarrhoea, blood in stool, abdominal pain and fever usually led to action (mainly self-medication, with allopathic drugs being used four to five times more often than herbal treatment). On average 20% of schistosomiasis-related signs and symptoms were reported to health facilities either as the first option or second and third alternative by some of those that self-medicated. A few of those who visited a clinic or health centre as first option still self-medicated afterwards. Children under 10 years and adults were more likely to seek health care than teenagers. Also, females were more likely to visit a health facility than males of the same age groups. Socio-economic status and duration of symptoms did not appear to affect health-seeking behaviour. 'Do not have the money' (43%) and 'Not serious enough' (41%) were the commonest reasons for not visiting a clinic, reported more frequently by lower and higher socio-economic classes, respectively, for both urinary or intestinal schistosomiasis. The regular health service shows some potential in passive control of schistosomiasis as some, but far too few, people visit a health facility as first or second option.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Danso-Appiah
authors.forename: S J
authors.initials: SJ
authors.lastname: De Vlas
authors.forename: K M
authors.initials: KM
authors.lastname: Bosompem
authors.forename: J D F
authors.initials: JD
authors.lastname: Habbema
mesh_terms: D000293:Adolescent; D000328:Adult; D000871:Anthelmintics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000209:etiology; D005260:Female; D005869:Ghana; D007722:Health Knowledge, Attitudes, Practice; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012424:Rural Population; D012553:Schistosomiasis haematobia / Q000523:psychology / Q000628:therapy*; D012555:Schistosomiasis mansoni / Q000523:psychology / Q000628:therapy*
chemical_list: D000871:Anthelmintics