Illness and health behaviour in Addis Ababa and rural central Ethiopia

Kloos, Helmut; Etea, Alemayehu; Degefa, Assefa; Aga, Hundessa; Berhanu, Solomon; Abera, Kabede; Abegaz, Abebe; Belemo, Geto

doi:10.1016/0277-9536(87)90005-0

Cited by 60 publications

(32 citation statements)

References 12 publications

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“…Visits to holy water sources as recourse for treatment or healing are reported in 46% of the cases; 11% of the deceased visited a traditional healer. This figure is lower than other reports of alternative medicine use in Ethiopia, but unlike these other studies, our data do not account for self-medication in minor conditions (Kloos et al 1987;Gedif and Hahn 2002). Both holy water and traditional healer visits are reported more often for TB/AIDS deaths.…”

Section: Resultscontrasting

confidence: 94%

“…The effect of age follows an inverse u-shaped pattern with the odds reaching a maximum at age 36. Declining health care utilization in old age has previously been observed for minor conditions as well as in terminal illness (Kloos et al 1987;Fantahun and Degu 2003;Case et al 2005). The odds of having visited a medical facility are highest among those who have been ill for more than 1 month.…”

Section: Resultsmentioning

confidence: 81%

“…Heart attack and stroke, for example, are more common in late adulthood and may result in an immediate death and thus a small window of opportunity to seek medical care. 5 Other potential reasons for lower health care utilization in older age are the lack of mobility in the elderly (Kloos et al 1987) or the unequal distribution of household resources for health care. While consulting a traditional healer follows a similar age pattern as modern medical services, holy water visits do not: the elderly are the most likely to turn to holy water sources for curative purposes.…”

Section: Discussionmentioning

confidence: 99%

“…As in other developing countries, health services are often provided through several, sometimes overlapping, channels that include both modern and traditional forms of medicine and healing (Beals 1976;Feierman 1981;Kroeger 1983;Hunte and Sultana 1992;Develay et al 1996;Ngalula et al 2002;Nyamongo 2002;Hatchett et al 2004;Case et al 2005;de-Graft Aikins 2005). In Addis Ababa, the treatment with self-administered medicine (herbal or modern) and the pursuit of other alternative curative options are relatively common, despite the widespread availability of relatively cheap modern medical services (Kloos et al 1987;Gedif and Hahn 2002).…”

Section: Introductionmentioning

confidence: 99%

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Health services utilization during terminal illness in Addis Ababa, Ethiopia

Reniers¹,

Tesfai²

2009

Health Policy and Planning

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ObjectivesWe describe modern and alternative health services use in terminal illness of adults, and assess whether utilization patterns of TB/AIDS patients are distinct from those of patients suffering from other illnesses. MethodsData are from post-mortem interviews with close relatives or caretakers of the deceased. We provide descriptive statistics of health care utilization in adults and discuss their covariates in multivariate analyses. ResultsOver 85% of terminally sick patients visited a modern medical facility, but less than 40% spent more than 24 hours in a medical facility and only 25% died in one. Traditional healer (11%) and holy water (46%) visits offer a common treatment and healing alternative, but these visits do not co-vary in any consistent manner with the utilization of modern medical services. In terms of the cause of death, we find a higher contact rate with both modern and alternative medical service providers among TB/AIDS patients compared with those suffering from other medical conditions. The duration of illness seems to account for a good share of that variability. Other covariates of health services utilization are socio-economic status, education and age.Conclusions The contact rate of adults with modern medical facilities in terminal illness is almost universal, but their usage intensity is rather low. Alternative curative options are less commonly used, and do not exclude modern health services use. This suggests that both types of services are considered complements rather than alternatives for each other. Because the contact rate with health service providers is greatest for TB/AIDS patients, it is unlikely that HIV/AIDS-related stigma is an impediment to seeking care. We cannot exclude, however, that it delays health-seeking behaviour.

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Section: Resultscontrasting

confidence: 94%

Section: Resultsmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Health services utilization during terminal illness in Addis Ababa, Ethiopia

Reniers¹,

Tesfai²

2009

Health Policy and Planning

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“…Household responses to illness are influenced by socioeconomic and cultural factors (Kleinman 1980;CunninghamBurley 1990) and by ease of access to treatment sources (Stock 1985;Kloos et al 1987;Mburu et al 1987;Glik et al 1989). In sub-Saharan Africa, rural and urban populations differ demographically, in socio-economic and cultural composition, and in proximity to formal and informal treatment sources.…”

Section: Introductionmentioning

confidence: 99%

Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya

Molyneux

Mung’ala‐Odera

Harpham

et al. 1999

Tropical Med Int Health

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SummaryUrbanization is an important demographic phenomenon in sub-Saharan Africa, and rural-urban migration remains a major contributor to urban growth. In a context of sustained economic recession, these demographic processes have been associated with a rise in urban poverty and ill health. Developments in health service provision need to reflect new needs arising from demographic and disease ecology change. In malariaendemic coastal Kenya, we compared lifelong rural (n ϭ 248) and urban resident (n ϭ 284) Mijikenda mothers' responses to childhood fevers. Despite marked differences between the rural and urban study areas in demographic structure and physical access to biomedical services, rural and urban mothers' treatment-seeking patterns were similar: most mothers sought only biomedical treatment (88%). Shop-bought medicines were used first or only in 69% of the rural and urban fevers that were treated, and government or private clinics were contacted in 49%. A higher proportion of urban informal vendors stocked prescription-only drugs, and urban mothers more likely to contact a private than a government facility. We conclude that improving self-treatment has enormous potential to reduce morbidity and mortality in low-income urban areas, as has frequently been argued for rural areas. However, because of the underlying socio-economic, cultural and structural differences between rural and urban areas, rural approaches to tackle this may have to be modified in urban environments.keywords malaria, maternal treatment-seeking, shops, health facility access, Kenya correspondence Sassy Molyneux,

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