title: Under-utilization of health care services for infectious diseases syndromes in rural Azerbaijan: a cross-sectional study.
abstract: BACKGROUND
  Infectious diseases present a potentially substantial yet undefined burden on the health of the adult Azerbaijani population. Efforts to quantify this burden in Azerbaijan are currently based almost exclusively on passive disease surveillance, and therefore hinge on the health utilization practices of the population. Understanding the prevalence of infectious syndromes and health utilization practices is paramount to disease surveillance, public health planning, and health care system reform.
  
  
  METHODS
  A two-stage, probability proportional to size sampling design was used to select a representative sample of three regions of northern Azerbaijan with village populations less than 500 people. Demographic, clinical, and epidemiologic parameters were assessed using prevalence odds ratios, chi-squared, and the Fisher exact test. Associations with p < 0.10 were included in the regression analysis and removed by backward elimination. Respondents included 796 adults from 39 villages.
  
  
  RESULTS
  Self-medication with antibiotics was the predominant utilization practice reported (19.4%). Only 1.3% of respondents reported seeing a health care provider for an infection, and 3.4% missed work or stayed in bed during the day in the last 5 years. In contrast, 338 illness episodes were reported in a 5 year period. Antibiotic use was significantly associated with gender, region, history of febrile illness, sleep disturbances, and arthritis controlling for age, ethnicity, and education. Influenza-like illness was the most prevalent infectious syndrome reported (33.3%).
  
  
  CONCLUSIONS
  We observed a remarkably low utilization of health services, despite reported symptoms that would merit use. Widespread availability of antibiotics may deter health care use, and may contribute to the development of antibiotic resistance in this population. Information on utilization of health services during an infection is essential for development of effective intervention strategies, and data on the prevalence of infectious syndromes provides information not otherwise available in populations with low health care utilization.
authors.affiliation: Walter Reed Army Institute of Research, Silver Spring, Maryland, USA. dvclark@gmail.com
authors.forename: Danielle V
authors.initials: DV
authors.lastname: Clark
authors.forename: Afrail
authors.initials: A
authors.lastname: Ismayilov
authors.forename: Sevinj
authors.initials: S
authors.lastname: Bakhishova
authors.forename: Huseyn
authors.initials: H
authors.lastname: Hajiyev
authors.forename: Tahir
authors.initials: T
authors.lastname: Nuriyev
authors.forename: Saleh
authors.initials: S
authors.lastname: Piraliyev
authors.forename: Sadigulla
authors.initials: S
authors.lastname: Bagirov
authors.forename: Afag
authors.initials: A
authors.lastname: Aslanova
authors.forename: Maqsud
authors.initials: M
authors.lastname: Qasimov
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hepburn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001382:Azerbaijan / Q000453:epidemiology; D003141:Communicable Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D055815:Young Adult