title: Healthcare seeking behaviour for Buruli ulcer in Benin: a model to capture therapy choice of patients and healthy community members.
abstract: Buruli ulcer is a devastating condition emerging in West Africa. We investigated why patients often report late to the hospital. Health seeking behaviour determinants and stigma were studied by in-depth interviews in patients treated in hospital (n=107), patients treated traditionally (n=46) of whom 22 had active disease, and healthy community control subjects (n=107). We developed a model capturing internal and external factors affecting decision making. With increasing severity, extent and duration of Buruli ulcer, a shift of influencing factors on health seeking behaviour appears to occur. Factors causing delay in presenting to hospital were the use of traditional medicine before presenting at the treatment centre; costs and duration of admission; disease considered not serious enough; witchcraft perceived as the cause of disease; and fear of treatment, which patients expected to be amputation. This study confirms the importance of self-treatment and traditional healing in this area. Our study was performed before antimicrobial treatment was introduced in Benin; we suggest that this model and the results from this analysis should be used as a baseline from which to measure the influence of the introduction of antimicrobial treatment on health seeking behaviour for Buruli ulcer in Benin.
authors.affiliation: University Medical Center Groningen, Department of Internal Medicine, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: Annelies A
authors.initials: AA
authors.lastname: Mulder
authors.forename: Roelien P
authors.initials: RP
authors.lastname: Boerma
authors.forename: Yves
authors.initials: Y
authors.lastname: Barogui
authors.forename: Claude
authors.initials: C
authors.lastname: Zinsou
authors.forename: R Christian
authors.initials: RC
authors.lastname: Johnson
authors.forename: Jules
authors.initials: J
authors.lastname: Gbovi
authors.forename: Tjip S
authors.initials: TS
authors.lastname: van der Werf
authors.forename: Ymkje
authors.initials: Y
authors.lastname: Stienstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001541:Benin; D054312:Buruli Ulcer / Q000523:psychology* / Q000628:therapy; D002648:Child; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011287:Prejudice; D011795:Surveys and Questionnaires