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No longer diseases of the wealthy: prevalence and health-seeking for self-reported chronic conditions among urban poor in Southern India

Upendra Bhojani, Thriveni S Beerenahalli, Roopa Devadasan, CM Munegowda, Narayanan Devadasan, Bart Criel and Patrick Kolsteren UGent (2013) BMC HEALTH SERVICES RESEARCH. 13.
abstract
Background: The burden of chronic conditions is high in low-and middle-income countries and poses a significant challenge to already weak healthcare delivery systems in these countries. Studies investigating chronic conditions among the urban poor remain few and focused on specific chronic conditions rather than providing overall profile of chronic conditions in a given community, which is critical for planning and managing services within local health systems. We aimed to assess the prevalence and health-seeking behaviour for self-reported chronic conditions in a poor neighbourhood of a metropolitan city in India. Methods: We conducted a house-to-house survey covering 9299 households (44514 individuals) using a structured questionnaire. We relied on self-report by respondents to assess presence of any chronic conditions, including diabetes and hypertension. Multivariable logistic regression was used to analyse the prevalence and health-seeking behaviour for self-reported chronic conditions in general as well as for diabetes and hypertension in particular. The predictor variables included age, sex, income, religion, household poverty status, presence of comorbid chronic conditions, and tiers in the local health care system. Results: Overall, the prevalence of self-reported chronic conditions was 13.8% (95% CI = 13.4, 14.2) among adults, with hypertension (10%) and diabetes (6.4%) being the most commonly reported conditions. Older people and women were more likely to report chronic conditions. We found reversal of socioeconomic gradient with people living below the poverty line at significantly greater odds of reporting chronic conditions than people living above the poverty line (OR = 3, 95% CI = 1.5, 5.8). Private healthcare providers managed over 80% of patients. A majority of patients were managed at the clinic/health centre level (42.9%), followed by the referral hospital (38.9%) and the super-specialty hospital (18.2%) level. An increase in income was positively associated with the use of private facilities. However, elderly people, people below the poverty line, and those seeking care from hospitals were more likely to use government services. Conclusions: Our findings provide further evidence of the urgent need to improve care for chronic conditions for urban poor, with a preferential focus on improving service delivery in government health facilities.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
urban poor, India, non-communicable diseases, prevalence, healthcare seeking, PROFILE, POPULATION, RISK-FACTORS, NORTHERN INDIA, slum, NONCOMMUNICABLE DISEASES, chronic conditions
journal title
BMC HEALTH SERVICES RESEARCH
BMC Health Serv. Res.
volume
13
article number
306
pages
10 pages
Web of Science type
Article
Web of Science id
000323119100002
JCR category
HEALTH CARE SCIENCES & SERVICES
JCR impact factor
1.659 (2013)
JCR rank
45/86 (2013)
JCR quartile
3 (2013)
ISSN
1472-6963
DOI
10.1186/1472-6963-13-306
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
4158400
handle
http://hdl.handle.net/1854/LU-4158400
date created
2013-10-08 21:25:02
date last changed
2016-12-21 15:42:06
@article{4158400,
  abstract     = {Background: The burden of chronic conditions is high in low-and middle-income countries and poses a significant challenge to already weak healthcare delivery systems in these countries. Studies investigating chronic conditions among the urban poor remain few and focused on specific chronic conditions rather than providing overall profile of chronic conditions in a given community, which is critical for planning and managing services within local health systems. We aimed to assess the prevalence and health-seeking behaviour for self-reported chronic conditions in a poor neighbourhood of a metropolitan city in India.
Methods: We conducted a house-to-house survey covering 9299 households (44514 individuals) using a structured questionnaire. We relied on self-report by respondents to assess presence of any chronic conditions, including diabetes and hypertension. Multivariable logistic regression was used to analyse the prevalence and health-seeking behaviour for self-reported chronic conditions in general as well as for diabetes and hypertension in particular. The predictor variables included age, sex, income, religion, household poverty status, presence of comorbid chronic conditions, and tiers in the local health care system.
Results: Overall, the prevalence of self-reported chronic conditions was 13.8\% (95\% CI = 13.4, 14.2) among adults, with hypertension (10\%) and diabetes (6.4\%) being the most commonly reported conditions. Older people and women were more likely to report chronic conditions. We found reversal of socioeconomic gradient with people living below the poverty line at significantly greater odds of reporting chronic conditions than people living above the poverty line (OR = 3, 95\% CI = 1.5, 5.8). Private healthcare providers managed over 80\% of patients. A majority of patients were managed at the clinic/health centre level (42.9\%), followed by the referral hospital (38.9\%) and the super-specialty hospital (18.2\%) level. An increase in income was positively associated with the use of private facilities. However, elderly people, people below the poverty line, and those seeking care from hospitals were more likely to use government services.
Conclusions: Our findings provide further evidence of the urgent need to improve care for chronic conditions for urban poor, with a preferential focus on improving service delivery in government health facilities.},
  articleno    = {306},
  author       = {Bhojani, Upendra and Beerenahalli, Thriveni S and Devadasan, Roopa and Munegowda, CM and Devadasan, Narayanan and Criel, Bart  and Kolsteren, Patrick},
  issn         = {1472-6963},
  journal      = {BMC HEALTH SERVICES RESEARCH},
  keyword      = {urban poor,India,non-communicable diseases,prevalence,healthcare seeking,PROFILE,POPULATION,RISK-FACTORS,NORTHERN INDIA,slum,NONCOMMUNICABLE DISEASES,chronic conditions},
  language     = {eng},
  pages        = {10},
  title        = {No longer diseases of the wealthy: prevalence and health-seeking for self-reported chronic conditions among urban poor in Southern India},
  url          = {http://dx.doi.org/10.1186/1472-6963-13-306},
  volume       = {13},
  year         = {2013},
}

Chicago
Bhojani, Upendra, Thriveni S Beerenahalli, Roopa Devadasan, CM Munegowda, Narayanan Devadasan, Bart Criel, and Patrick Kolsteren. 2013. “No Longer Diseases of the Wealthy: Prevalence and Health-seeking for Self-reported Chronic Conditions Among Urban Poor in Southern India.” Bmc Health Services Research 13.
APA
Bhojani, U., Beerenahalli, T. S., Devadasan, R., Munegowda, C., Devadasan, N., Criel, B., & Kolsteren, P. (2013). No longer diseases of the wealthy: prevalence and health-seeking for self-reported chronic conditions among urban poor in Southern India. BMC HEALTH SERVICES RESEARCH, 13.
Vancouver
1.
Bhojani U, Beerenahalli TS, Devadasan R, Munegowda C, Devadasan N, Criel B, et al. No longer diseases of the wealthy: prevalence and health-seeking for self-reported chronic conditions among urban poor in Southern India. BMC HEALTH SERVICES RESEARCH. 2013;13.
MLA
Bhojani, Upendra, Thriveni S Beerenahalli, Roopa Devadasan, et al. “No Longer Diseases of the Wealthy: Prevalence and Health-seeking for Self-reported Chronic Conditions Among Urban Poor in Southern India.” BMC HEALTH SERVICES RESEARCH 13 (2013): n. pag. Print.