title: Health Seeking Behaviour and Treatment Intentions of Dengue and Fever: A Household Survey of Children and Adults in Venezuela.
abstract: BACKGROUND
  Dengue in Venezuela is a major public health problem with an increasing incidence of severe cases. Early diagnosis and timely treatment influences the outcome of dengue illness, as delay in care-seeking is significantly associated with complications leading to severe dengue. We aimed to understand patterns of health seeking behaviour (HSB) in individuals exposed to high dengue incidence in order to improve early attendance to health centres.
  
  
  METHODS
  Between September 2013 and February 2014 a cross-sectional household survey was performed in Maracay, Venezuela. Intended HSB of adults and children's parents/guardians was assessed with respect to fever or suspected dengue. Data was collected through structured questionnaires from 105 individuals.
  
  
  RESULTS
  Most individuals felt at risk of dengue and believed it could be a deadly disease. In the case of suspected dengue, the majority (60%) would choose to first seek medical help versus first treating at home, in contrast to 11% in the case of fever. Amongst those who decided to visit a doctor, a suspected dengue infection would prompt them to search medical help earlier than if having only fever (p<0.001). Multivariate analysis modelling showed that the independent factors associated with the intention to firstly visit a doctor versus treating at home in the case of dengue were feeling at risk (OR = 3.29; p = 0.042) and being an adult (as opposed to caring for a child as a parent/guardian; OR = 3.33, p = 0.021), while having had a previous dengue infection (OR = 0.29; p = 0.031) and living in the neighbourhood Caña de Azúcar (OR = 0.28, p = 0.038) were negatively associated with seeking medical care as their first action.
  
  
  CONCLUSIONS
  Knowledge of HSB related to dengue is scarce in the Americas, our study attempts to contribute to a better understanding of HSB in this region. Improving early dengue disease recognition and awareness may enhance prompt attendance to medical care in affected populations and thereby reduce mortality and severity of dengue. Especially for those with a previous dengue infection, efforts have to be made to promote prompt health centre attendance.
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jelte
authors.initials: J
authors.lastname: Elsinga
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Instituto de Investigaciones Biomédicas, Universidad de Carabobo, Maracay, Venezuela.
authors.forename: Erley F
authors.initials: EF
authors.lastname: Lizarazo
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Instituto de Investigaciones Biomédicas, Universidad de Carabobo, Maracay, Venezuela.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Vincenti
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Masja
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Departamento de Biología, Facultad Experimental de Ciencia y Tecnología, Universidad de Carabobo, Valencia, Venezuela.
authors.forename: Zoraida I
authors.initials: ZI
authors.lastname: Velasco-Salas
authors.affiliation: Instituto de Investigaciones Biomédicas, Universidad de Carabobo, Maracay, Venezuela.
authors.forename: Luzlexis
authors.initials: L
authors.lastname: Arias
authors.affiliation: Population Research Center, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bailey
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Departamento de Parasitología, Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia, Venezuela.
authors.forename: Adriana
authors.initials: A
authors.lastname: Tami
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003715:Dengue / Q000628:therapy*; D005191:Family Characteristics; D005260:Female; D005334:Fever / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011795:Surveys and Questionnaires; D014687:Venezuela; D055815:Young Adult