RESUMO
Few empirical investigations into the nature of health services utilization fully acknowledge that the home environment may act as a socio-geographical focus of both disease transmission and of learned health behaviour. This paper examines the role of the home environment, as well as of personal characteristics and accessibility, in the utilization of health services in Grenada, West Indies. Bivarite and logit analysis of household survey data are employed to identify markers of high user individuals and households. Aspects of each domain of the home environment (physical and behavioral environment, demographies, and residential mobility) emerge as contributors to the utilization phenomenon in the study communities. Both etiological and socio-economic linkages are postulated to underlie the observed relationships. The implications of this work for health planning in developing countries is discussed. (AU)
Assuntos
Serviços de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Fatores Etários , Aleitamento Materno , Acessibilidade aos Serviços de Saúde/economia , Habitação , Higiene , Projetos de Pesquisa , Fatores Sexuais , Fatores Socioeconômicos , Abastecimento de Água , GranadaRESUMO
In a previous paper (Soc Sci Med 23, 995-1002, 1986), we described the development of a method for identifying households at high risk of childhood diarrhea based on a logit analysis of data collected as part of a diarrhea disease control project in Grenada. In this paper, we report the results of a follow-up study designed to replicate the first using data on diarrhea incidence and risk factors collected in a different set of rural communities in Grenada. The findings of the first study were not replicated. There was no significant association between the risk factors and diarrhea in the follow-up study in contrast to the very strong associations found in the first study. As a consequence, it was not possible to construct a logit model from the second data set. The possible reasons for the contrasting sets of results and their implications for the application of the risk approach are discussed with reference to a two by two true-false table. (AU)
Assuntos
Humanos , Diarreia/prevenção & controle , Diarreia/epidemiologia , Seguimentos , Educação em Saúde , Habitação , Higiene , Modelos Logísticos , Projetos de Pesquisa , Fatores de Risco , Saúde da População Rural , GranadaRESUMO
Calls for household surveys to provide information on service utilization in less developed countries raise questions regarding the accuracy and reliability of reporting. This paper compares reported to recorded health service utilization for diarrhoea and any other morbidity over a 2-week and 3-month period for information obtained from a household survey in Grenada, West Indies. A sensitivity analysis is used to derive minimum and maximum estimates of the accuracy of reported utilization. Over-reporting utilization was found to be between 33 and 62 percent for diarrhoea and 49 and 81 percent for any other morbidity. Under-reporting of all utilization was estimated to be between 47 and 65 percent. These results cast doubt on the utility of household surveys as a reliable source of information regarding service utilization. (AU)