Determinants of healthcare utilisation for low back pain: A population‐based study in Ethiopia

Abstract

Low back pain (LBP) remains one of the major public health problems worldwide. However, in low‐income countries, such as those in Africa, the epidemiological data on healthcare utilisation for LBP are lacking due to more pressing problems such as infectious diseases, to which the majority of health resources are channelled. Therefore, this study aimed at investigating the determinants of healthcare utilisation for LBP in the general population of Ethiopia. A population‐based cross‐sectional study was conducted in South‐West Shewa zone of Ethiopia from June to November 2018. The data were collected by interviewing adults with LBP (n = 1812, randomly selected) using a psychometrically tested and validated instrument, analysed using R version 3.5.1. A log‐binomial regression model was used to determine the prevalence ratio with a 95% confidence interval (CI) in identifying factors associated with healthcare utilisation for LBP. Estimates of population parameters were also presented with 95% CIs and p values. For all applications of inferential statistics, a p value of ≤.05 was taken as the significance level. The lifetime prevalence of healthcare utilisation for LBP was 36.1%, 95% CI: 33.9–38.1, while the annual prevalence rate was 30%, 95% CI: 27.9–32.2. Of those with a 1‐year history of healthcare utilisation, while 7.4%, 95% CI: 4.9–10.3 rural and 36.6%, 95% CI: 29.5–44 urban populations utilised healthcare from general hospitals, 1.4%, 95% CI: 0.3–2.7 rural and 6.8%, 95% CI: 3.1–10.8 urban populations utilised healthcare from specialised hospitals. Several sociodemographic factors, modifiable health behaviours/lifestyle habits, pain interrelated factors, and specific factors such as beliefs about the pain, depressive symptoms and insomnia were associated with healthcare utilisation for LBP. The implications of this research are that it may be prudent for the Ethiopian healthcare policy makers to develop the necessary strategies to meet the health needs of both urban and rural populations with LBP.

Cross-cultural adaptation and psychometric evaluation of the Yoruba version of the Back beliefs questionnaire among patients with chronic low-back pain

“…The new tool may promote assessment of beliefs about chronic pain and also inform interventions to improve health outcomes of Yoruba speaking patients with chronic LBP. Anecdotal and empirical reports indicate that African patients with chronic pain have psychosocial problems, in this case, unhelpful beliefs, that have strong cultural undercurrents which in turn affect their health seeking behaviour [39,40]. Early identification of patients with unhelpful beliefs about LBP is of utmost importance.…”

Hospital admission and associated factors among individuals presenting to healthcare facilities for low back pain in Ethiopia

“…Thus, the remaining 543 individuals who reported at least 1 presentation to any of the health institutions for their LBP in the past 1‐year were included in the analysis of this paper (Figure 1). The detailed procedure that includes sample size calculation, sampling technique, the identification of individuals with LBP, and data collection, is described elsewhere 27 …”

“…The detailed procedure that includes sample size calculation, sampling technique, the identification of individuals with LBP, and data collection, is described elsewhere. 27…”

“…This variation in point of healthcare utilization was suggested to be a product of the difference in socio-economic status between the rural and the urban populations. 27 In addition, the availability of health services also explains the observed difference in point of healthcare utilization for LBP.…”

The Lancet Series call to action to reduce low value care for low back pain: an update

“…A 2020 population study in Central Ethiopia (N = 1812) found that 30% (95% CI 27.9-33.2) of the population had sought health care for low back pain in the previous year. 6 Of these 77% were treated with injected medications. There was a strong relationship between educational level and receiving back pain treatment, with those with a degree more likely to receive treatment compared to people with no education (adjusted proportion ratio = 1.68 [95% CI 1.44-1.99]).…”