Supervisor: Prof T Hesketh

Care-seeking behaviour in acute febrile illness Dissertation presentation – literature review and analysis of an existing data set

Dissertation presentation:Overview

✤ Topic: Care-seeking behaviour of Burmese migrants with severe febrile illness presenting to clinics on the Thai-Burma border

✤ Background and objectives

✤ Part 1 - literature review

✤ Methodology

✤ Themes

✤ Part 2 - data analysis

✤ The data

✤ Methodology

Background

✤ Burmese army fighting indigenous groups

✤ Refugees cross Thai-Burma border

✤ 200,000 refugees outside camps, 150,000 in camps

✤ Shoklo Malaria Research Unit

✤ 4 clinics for refugees and migrant workers

Dissertation Objectives

✤ I - To review the evidence relating to care-seeking behaviour of this Burmese migrant population and of other people in Asia in acute febrile illness

✤ II - To describe the care-seeking journey of Burmese migrants attending clinics on the Thai-Burma border in Tak Province in cases of severe febrile illness

✤ III - To identify associations between time taken to reach care and severity of illness / sociodemographic characteristics / symptoms

Part I - Literature review Questions

✤ What is known about the care-seeking behaviour of Burmese people living on the Thai-Burma border in acute febrile illness?

✤ What is known about the care-seeking behaviour of people in Asia, both migrants and non-migrants, in acute febrile illness?

Part I - Literature reviewMethodology✤ Sources: Pubmed / Medline, Cochrane Library, JSTOR,

Web of Knowledge, Google Scholar, Burma library

✤ Search terms 1: (“Thai-Burma border”) AND (“care-seeking” OR “access”). Articles screened for: relevance to acute febrile illness, populations outside refugee camps

✤ Search terms 2: (“care-seeking” AND “fever” OR “pneumonia” OR “malaria” OR “acute” OR “Asia”). Articles screened for: referring to Asia and acute febrile illness

✤ Five key themes

Part II - Data analysisThe data✤ 322 interviews with in-patients at 3 clinics

✤ Data: symptoms, duration, places care sought, why, barriers, costs

✤ Consultation with Tak Border Community Ethical Advisory Group

✤ Ethical approval: Oxford Tropical Research Ethics Committee

✤ Pre-testing, revision, consent

✤ Describe care-seeking journey

✤ Identify associations

Part II - Data analysisMethodology for analysis✤ Summary of:

✤ Socio-demographic characteristics

✤ Symptoms of illness and duration

✤ Healthcare providers used, reasons for choices and reasons for delays

✤ Methods of transport used, cost and time to reach clinic

✤ Clinical diagnoses (and how these relate to symptoms)

✤ Further analysis:

✤ Flow charts of pathways to in-patient care

✤ Relationship between markers of severity and time taken to reach care (univariate analysis)

✤ Relationship between sociodemographic factors / symptoms of illness and time to care (multivariate analysis)

Summary✤ Background

✤ Objectives

✤ Literature review

✤ The dataset

✤ Data analysis

Thank you. Any questions?

References✤ Ettling, M.B., Krongthing T, Somsak K, Pongwit B (1989) Malaria clinics in Mae sot, Thailand: factors affecting clinic attendance Southeast Asian J Trop Med

Public Health, 20 (3): 331-340

✤ Isarabhakdi Pimonpan (2004) Meeting at the Crossroads: Myanmar Migrants and Their Use of Thai Health Care Services Asian and Pacific Migration Journal, 13 (1):107-126. Available at http://www.whothailand.org/LinkFiles/Border_Health_Meeting_at_the_Crossroads_DrPimonphan.pdf. Last accessed 18/03/2012.

✤ Shoklo Malaria Research Unit (no date) Malaria Handbook, available at http://www.shoklo-unit.com/Handout/. Accessed 13/04/2012.

✤ Thailand Burma Border Consortium, 2012. Programme Report 2011 July to December. Available at http://www.tbbc.org/resources/resources.htm#reports. Accessed 11/04/2012.

✤ United Nations Statistics Division (2011) Composition of macro geographical (continental) regions. Available at http://unstats.un.org/unsd/methods/m49/m49regin.htm. Last accesed 30/05/2012.

✤ World Health Organisation (1991). Technical Basis for the WHO Recommendation on the Management of Pneumonia in Children at First-level Health Facilities. Available at http://www.who.int/maternal_child_adolescent/documents/ari_91_20/en/. Accessed 13/04/2012.

✤ World Health Organisation and UNICEF (2004) Joint Statement: management of pneumonia in community settings. Geneva / New York: WHO/UNICEF. Available at http://whqlibdoc.who.int/hq/2004/WHO_FCH_CAH_04.06.pdf. Last accessed 18/04/2012.

✤ World Health Organisation (2010). Accelerating Progress Towards the Millenium Development Goals. Available at http://www.who.int/topics/millennium_development_goals/MDG-NHPS_brochure_2010.pdf. Accessed 11/04/2012.