Fever and health-seeking behaviour among migrants living along the Thai-Myanmar border: a mixed-methods study

Abstract

The decline of malaria in Southeast Asia has complexified how fever is perceived and what actions are taken towards it. Using a mixed-methods design, we investigated the concept of fever and the determinants influencing health-seeking behaviour among migrants on the Thai-Myanmar border, where rapid economic developments collide with precarious political and socio-economic conditions. Fever corresponded with a high diversity of terms, symptoms and believed causes. The qualitative analysis identified distance and legal status as key barriers for accessing health care. The quantitative analysis further investigated determinants influencing health-seeking behaviour: living near a town where a cost-free clinic operated was inversely associated with seeking care at health posts (adjusted odds ratio [aOR], 0.40, 95% confidence interval [95% CI] [0.19-0.86]), and public hospital attendance (aOR 0.31, 95% CI [0.14-0.67]). Living further away from the nearest town was associated with health posts attendance (aOR 1.05, 95% CI [1.00-1.10] per 1 km). Having legal status was inversely associated with cost-free clinics attendance (aOR 0.27, 95% CI [0.10-0.71]), and positively associated with private clinic (aOR 2.56, 95% CI [1.00-6.54]) and public hospital attendance (aOR 5.15, 95% CI [1.80-14.71]). Fever conception and believed causes are context-specific and should be investigated prior to any intervention.

Community‐level incidence and treatment seeking during febrile illness: Insights from health behaviour surveys in rural Thailand and Laos

“…Lastly, the survey data also captured a range of demographic and socio‐economic variables that were likely to have an influence on fever treatment‐seeking behaviour [16, 23, 33–37]. Representing common ‘control variables’ in social research, the main variables included in this study were the sex of the survey respondent ([1] if female), age group (18–24, 25–34, 35–44, 45–59, 60+ and 0–4 and 5–17 if respondents reported on illness episodes of minors under their supervision), education (number of completed years of formal education), language ability ([1] if respondent spoke the main language of Thai/Lao in the respective study site), ethnicity ([1] if respondent belonged to the majority ethnic Thai/Khon Mueang groups in Chiang Rai or Lao Loum in Salavan), religion ([1] if respondent belonged to the majority religion of Buddhism in either site), occupation (comprising different types of precarious and secure employment such as daily labourers and drivers vs. contractual employees and government workers), housing conditions (on an ordinally decreasing scale from [1] stone, [2] wood and [3] natural materials), a wealth index (calculated on a scale from [0–1] of ownership of 16 common household assets and amenities such as a fridge and a rice cooker) and specific assets and amenities that likely influenced treatment‐seeking behaviour (electricity at home, water access, owning a motor vehicle) and the respondents' distance to the nearest markets and healthcare sources.…”