Study On The Cause And Influences Factors Of Delay Health Seeking Of Intestinal Infectious Disease

BackgroundsThe infectious disease had once been one of the most deathful diseases to human being. As the invention of microscope and the discovery and widely used of antibiotics, the infectious disease had been considered be controlled by mankind. The incidence and mortality rate of the infectious disease had been lower and lower. But during the last decades, there has been more and more infectious disease both of kinds and cases occurred. Several new kinds of infectious disease had been discovered, SARS,AIDS/HIV, Avian influenza H5N1,West Nile Virus and Legionellosis are the best models, moreover some kinds of infectious diseases which once considered had been under entirely controlled are now resurgence, for example, schistosomiasis. For all these kinds of infectious disease reoccur, mostly contributed to the action of people themselves, the pollution of environment, the excess use of antibiotic and so on. Furthermore these infectious diseases have revealed that they have the different character, contrast to what they had before. The distribution of the infectious disease now may be in different ways, in different people, in different locations and at different seasons. It suggests that there would be a long way on which mankind'spreventing and controlling the infectious diseases.There are three ways in the infectious disease control: restrain the source of infection, cut off the way to infect and protect the susceptible hosts. Among these three ways, to restrain the source of infection should be very important method in infectious disease control. A person who had be infected by pathogenic microbe, has showed symptoms and signs of infectious disease through the incubation, will discharge more pathogenic microbe and would be danger to the people around him. Anyway, it is important to study the delay of infectious disease cases' health seeking.There are always many infectious diseases outbreaks because of seeking health delay during the work of infectious prevention and control. Here is an instance. An outbreak of infectious diarrhoea in a high school was due to the contaminated water, and 470 students were attacked. There had been 88.72% cases occurred before CDC got the information of the outbreak (417/470).What has been emphasizing on infectious disease prevention and control is the four earlinesses: early detection, early diagnoses, early quarantine and early treatment. But it is still late for infectious disease prevention and controlling, and the four earlinesses is still passive to hospital and CDC. How to make the infectious cases go to see a doctor as soon as possible to avoid the infectious disease spread widely should be considered an even more important matter.This study was to detect the cause and influence factors of delay health seeking of infectious disease cases, and hope to provide some evidence to the health administration in order to prevent and control infectious disease more effectively.Methods202 intestinal infectious disease cases were randomly selected from all the reported 1053 intestinal infectious disease cases in medical institutions of Zhuji city during July, 2003 to March, 2005 of, including hepatitis A & E, typhoid fever and paratyphoid fever, bacterial dysentery. The sample can reflect well in demography characters and the distribution of different kinds of intestinal infectious disease to thestudy population. Survey was fulfilled with a same questionnaire in the face-to-face investigation to all the cases. The cases were divided into two groups. One positive group meant delay group, whose period between being sickness and see a doctor was longer than or equal to the median of all cases, stratified by the different disease. Another group, negative group, meant underlay group, whose period between being sickness and see a doctor was shorter than the median of all cases, stratified by the different disease. The questionnaire contained several parts: population characteristic (sex, age, occupation, education level, marriage status, health insurance, economics status, and so on), the incidence status (time, severity level, and so on), situation of seeking for health services (first incident time, hospital and its diagnose, the last accurate diagnosis time, and so on), the cause of delay seeking for health services, etc. Single factor analysis and multiple logistic regression were used by SPSS.Results202 cases included 93 virus hepatitis cases, 49 typhoid and paratyphoid fever cases, 60 bacterial dysentery cases. The sex ratio was 1.89:1 (male: female), and the average age was 37.49±19. 40. Also it contains 136 peasants, 29 peasant-workers, 18 students and children, 19 others, while 132 married, 64 unmarried, 6 others. The average income per year was 7890 Yuan. The distribution of sample and study population showed no significant difference (P>0.05).The period between being sickness and see a doctor of the 202 cases was 0 day to 36 days, the median was 5 days. After data transformation, 96 cases (47.50%) belonged to the positive group and 106 cases (52.50%) to the negative group. Statistical test of single factor showed that in different groups, different age group (x~2=9.87, P=0.02) , occupation (x~2=10.08, P=0.02), hospitalization insurance or not (x~2=16.45, P=0.00) and acute or not(x~2=5.99, P=0.05) had significant difference. While there was no significant difference in other factors such as sex, marriage, education, income of family one person a year, severity of symptom, convenience or not to see a doctor and there had been or not similar cases among around people.(P>0.05). The multiple logistic regression showed that main factors which influence the cases see a doctor in time or not was income of family one person per year, hospitalization insurance and occupation. Those cases who had higher income per year or with hospitalization insurance seemed to see a doctor in time comparing to those lower income or without hospitalization insurance. Children and students showed seeing a doctor in shorter time than others, partly contributed to the attention of their parents.The single reason of delay was chosen by the 54 delayed cases, 30 (55.55%) due to neglect, 13 (24.07%) due to low income, 4 (7.41%) due to busy or needed unmentionable disease and 3 (5.55%) due to self-treatment. The other 42 cases chose the multiple reasons, mainly due to low income, neglect, without convenient traffic and self-treatment.As a result of delay, there were no significant difference between the two groups in course of disease, cost for treatment and secondly attack rate except the cure rate for bacterial dysentery (x~2=4.02, P=0.04), and the neglect group was higher.ConclusionsThe study shows that the influence factors of delay health seeking are low income group, without hospitalization insurance and different occupations. The delay contributes great partly to higher and higher fee-for-service. For there is different first discomfort in different intestinal infectious disease, and different cases shows different period in health seeking. To shorten the period between first symptom and see a doctor among infectious disease cases, several methods as below should be taken into account: to do more education to make public know more about infectious disease, to popularize more hospitalization insurance and to make fee-for-service moderate.