Data from: The relationship between poverty and healthcare seeking among patients hospitalized with acute febrile illnesses in Chittagong, Bangladesh

Delays in seeking appropriate healthcare can increase the case fatality of acute febrile illnesses, and circuitous routes of care-seeking can have a catastrophic financial impact upon patients in low-income settings. To investigate the relationship between poverty and pre-hospital delays for patients with acute febrile illnesses, we recruited a cross-sectional, convenience sample of 527 acutely ill adults and children aged over 6 months, with a documented fever ≥38.0°C and symptoms of up to 14 days’ duration, presenting to a tertiary referral hospital in Chittagong, Bangladesh, over the course of one year from September 2011 to September 2012. Participants were classified according to the socioeconomic status of their households, defined by the Oxford Poverty and Human Development Initiative’s multidimensional poverty index (MPI). 51% of participants were classified as multidimensionally poor (MPI>0.33). Median time from onset of any symptoms to arrival at hospital was 22 hours longer for MPI poor adults compared to non-poor adults (123 vs. 101 hours) rising to a difference of 26 hours with adjustment in a multivariate regression model (95% confidence interval 7 to 46 hours; P = 0.009). There was no difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394). Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001)—5.1% vs. 0.0% for poor and non-poor adults (P = 0.010) and 6.4% vs. 1.8% for poor and non-poor children (P = 0.083). Deaths were attributed to central nervous system infection (11), malaria (3), urinary tract infection (2), gastrointestinal infection (1) and undifferentiated sepsis (1). Both poor and non-poor households relied predominantly upon the (often informal) private sector for medical advice before reaching the referral hospital, but MPI poor participants were less likely to have consulted a qualified doctor. Poor participants were more likely to attribute delays in decision-making and travel to a lack of money (P<0.001), and more likely to face catastrophic expenditure of more than 25% of monthly household income (P<0.001). We conclude that multidimensional poverty is associated with greater pre-hospital delays and expenditure in this setting. Closer links between health and development agendas could address these consequences of poverty and streamline access to adequate healthcare.

未能及时寻求恰当的医疗救治会提升急性发热性疾病的病例病死率，而迂回的就医路径会对低收入地区的患者造成毁灭性的经济负担。为探究贫困与急性发热性疾病患者入院前延误救治之间的关联，我们于2011年9月至2012年9月的一年周期内，在孟加拉国吉大港的一所三级转诊医院招募了横断面便利样本，共纳入527名急性患病成人及6个月以上儿童；所有受试者均经确诊体温≥38.0℃，且症状持续时长不超过14天。研究对象按照其家庭的社会经济地位进行分类，分类依据为牛津贫困与人类发展倡议（Oxford Poverty and Human Development Initiative）的多维贫困指数（multidimensional poverty index, MPI）。其中51%的受试者被归类为多维贫困群体（MPI＞0.33）。相较于非贫困成人，贫困成人从出现任意症状到抵达医院的中位时长多22小时（123小时vs. 101小时）；经多变量回归模型校正后，这一差距扩大至26小时（95%置信区间7~46小时；P=0.009）。贫困与非贫困家庭的儿童在救治延误时长上无显著差异（97小时vs. 119小时；P=0.394）。贫困群体与非贫困群体的病例病死率分别为5.9%与0.8%（P=0.001）；其中贫困成人与非贫困成人的病死率分别为5.1%与0.0%（P=0.010），贫困儿童与非贫困儿童的病死率分别为6.4%与1.8%（P=0.083）。死亡病例的病因依次为中枢神经系统感染（11例）、疟疾（3例）、尿路感染（2例）、胃肠道感染（1例）以及未分型脓毒症（1例）。无论贫困与否，绝大多数家庭在抵达转诊医院前均主要依赖（通常为非正规的）私营部门获取医疗咨询，但多维贫困受试者咨询合格医师的概率更低。贫困受试者更倾向于将决策延误与出行延误归因于资金匮乏（P＜0.001），且更可能面临超过月家庭收入25%的灾难性医疗支出（P＜0.001）。本研究得出结论：在本次研究场景中，多维贫困与更长的入院前延误时长及更高的医疗支出显著相关。加强卫生与发展议程之间的联动，或可缓解贫困带来的这些负面影响，并优化合理医疗服务的可及性。