Final published version
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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Primary care doctor and nurse consultations among people who live in slums
T2 - a retrospective, cross-sectional survey in four countries
AU - Improving Health in Slums Collaborative
AU - Bakibinga, P.
AU - Kabaria, C.
AU - Kasiira, Z.
AU - Kibe, P.
AU - Kyobutungi, C.
AU - Mbaya, N.
AU - Mberu, B.
AU - Mohammed, S.
AU - Njeri, A.
AU - Azam, I.
AU - Iqbal, R.
AU - Nazish, A.
AU - Rizvi, N.
AU - Shifat Ahmed, S.A.K.
AU - Choudhury, N.
AU - Alam, O.
AU - Khan, A.Z.
AU - Rahman, O.
AU - Yusuf, R.
AU - Odubanjo, D.
AU - Ayobola, M.
AU - Fayehun, O.
AU - Omigbodun, A.
AU - Osuh, M.
AU - Owoaje, E.
AU - Taiwo, O.
AU - Lilford, R.J.
AU - Sartori, J.
AU - Watson, S.
AU - Diggle, P.J.
AU - Aujla, N.
AU - Chen, Y.-F.
AU - Conlan, C.
AU - Gill, P.
AU - Griffiths, F.
AU - Harris, B.
AU - Madan, J.
AU - Muir, H.
AU - Oyebode, O.
AU - Pitidis, V.
AU - de Albuquerque, J.P.
AU - Smith, S.
AU - Taylor, C.
AU - Tregonning, G.
AU - Ulbrich, P.
AU - Uthman, O.A.
AU - Wilson, R.
AU - Yeboah, G.
AU - Park, J.-E.
AU - Watson, S.
PY - 2022/1/7
Y1 - 2022/1/7
N2 - Objectives To survey on the availability and use of primary care services in slum populations. Design Retrospective, cross-sectional, household, individual and healthcare provider surveys. Setting Seven slum sites in four countries (Nigeria, Kenya, Pakistan and Bangladesh). Participants Residents of slums and informal settlements. Primary and secondary outcome measures Primary care consultation rates by type of provider and facility. Results We completed 7692 household, 7451 individual adult and 2633 individual child surveys across seven sites. The majority of consultations were to doctors/nurses (in clinics or hospitals) and pharmacies rather than single-handed providers or traditional healers. Consultation rates with a doctor or nurse varied from 0.2 to 1.5 visits per person-year, which was higher than visit rates to any other type of provider in all sites except Bangladesh, where pharmacies predominated. Approximately half the doctor/nurse visits were in hospital outpatient departments and most of the remainder were to clinics. Over 90% of visits across all sites were for acute symptoms rather than chronic disease. Median travel times were between 15 and 45 min and the median cost per visit was between 2% and 10% of a household's monthly total expenditure. Medicines comprised most of the cost. More respondents reported proximity (54%-78%) and service quality (31%-95%) being a reason for choosing a provider than fees (23%-43%). Demand was relatively inelastic with respect to both price of consultation and travel time. Conclusions People in slums tend to live sufficiently close to formal doctor/nurse facilities for their health-seeking behaviour to be influenced by preference for provider type over distance and cost. However, costs, especially for medicines are high in relation to income and use rates remain significantly below those of high-income countries. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
AB - Objectives To survey on the availability and use of primary care services in slum populations. Design Retrospective, cross-sectional, household, individual and healthcare provider surveys. Setting Seven slum sites in four countries (Nigeria, Kenya, Pakistan and Bangladesh). Participants Residents of slums and informal settlements. Primary and secondary outcome measures Primary care consultation rates by type of provider and facility. Results We completed 7692 household, 7451 individual adult and 2633 individual child surveys across seven sites. The majority of consultations were to doctors/nurses (in clinics or hospitals) and pharmacies rather than single-handed providers or traditional healers. Consultation rates with a doctor or nurse varied from 0.2 to 1.5 visits per person-year, which was higher than visit rates to any other type of provider in all sites except Bangladesh, where pharmacies predominated. Approximately half the doctor/nurse visits were in hospital outpatient departments and most of the remainder were to clinics. Over 90% of visits across all sites were for acute symptoms rather than chronic disease. Median travel times were between 15 and 45 min and the median cost per visit was between 2% and 10% of a household's monthly total expenditure. Medicines comprised most of the cost. More respondents reported proximity (54%-78%) and service quality (31%-95%) being a reason for choosing a provider than fees (23%-43%). Demand was relatively inelastic with respect to both price of consultation and travel time. Conclusions People in slums tend to live sufficiently close to formal doctor/nurse facilities for their health-seeking behaviour to be influenced by preference for provider type over distance and cost. However, costs, especially for medicines are high in relation to income and use rates remain significantly below those of high-income countries. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
KW - international health services
KW - organisation of health services
KW - primary care
KW - public health
KW - acute disease
KW - adult
KW - Article
KW - Bangladesh
KW - child
KW - chronic disease
KW - consultation
KW - cross-sectional study
KW - female
KW - general practitioner
KW - health care availability
KW - health care cost
KW - health care quality
KW - health care utilization
KW - hospital
KW - household
KW - human
KW - Kenya
KW - male
KW - middle aged
KW - Nigeria
KW - nurse
KW - outpatient care
KW - Pakistan
KW - patient preference
KW - pharmacy (shop)
KW - primary health care
KW - retrospective study
KW - traditional healer
KW - travel
KW - urban area
U2 - 10.1136/bmjopen-2021-054142
DO - 10.1136/bmjopen-2021-054142
M3 - Journal article
VL - 12
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 1
M1 - e054142
ER -