Prevalence and predictive factors for renouncing medical care in poor populations of Cayenne, French Guiana

Abstract

Background: Access to health care is a global public problem. In French Guiana, there exists social inequalities which are specially marked amongst immigrants who make up a third of the population. Health care inequalities are prevalent. The objective of this study was to determine factors associated with why health care amongst the poor population of Cayenne was renounced. The study was cross sectional. It focused on knowledge, attitudes, practices and beliefs of the population living in poor neighborhoods of the Cayenne area. Methods: Populations coming at the Red Cross mobile screening unit in poor urban areas of Cayenne were surveyed from July 2013 to June 2014. Structured questionnaires consisted of 93 questions. Written informed consent was requested at the beginning of the questionnaire. The predictors for renouncing medical care were determined using logistic regression models and tree analysis. Results: Twenty percent of persons had renounced care. Logistic regression showed that renouncement of health care was negatively associated with having no regular physician Adjusted Odds Ratio (AOR) = 0.43 (95 % CI = 0.24-0.79) and positively associated with being embarrassed to ask certain questions AOR = 6.81 (95 % CI = 3.98-11.65) and having been previously refused health care by a doctor AOR = 3.08 (95 % CI = 1.43-6.65). Tree analysis also showed that three of these variables were linked to renouncement, with feeling shy to ask certain questions as the first branching. Conclusion: Although most people felt it was easy to see a doctor, one in five had renounced health care. The variables identified by the models suggest vulnerable persons generally had previous negative encounters with the health system and felt unwanted or non eligible for healthcare. Health care mediation and welcoming staff may be simple solutions to the above problems which were underscored in our observations.

Wild medicinal plant collection in transitional societies: A case Analysis from French Guiana

“…In 2005, 30% of the total population of French Guiana was of immigrant origin 5 (Hurpeau, 2012), often living in precarious conditions in underprivileged neighbourhoods that sprang up out of nowhere (Auburtin, 2007(Auburtin, , 2006Gardel, 2001;Gorgeon, 1985;Romanovski & Piantoni, 2009). It is primarily to meet their primary care needs that urban populations collect certain medicinal plants from their surroundings, partially offsetting the difficulties they have in accessing conventional medicine (Carde, 2006;Jolivet, 1982;Valmy et al, 2015). In developing cities like Cayenne, its inhabitants maintain the herbal remedy and plant collection practices of their original cultures (Tareau et al, 2017).…”

“…Socio-economic differences also have a significant bearing on collection practices, since different living standards mean different access to biomedical healthcare (Valmy et al, 2015), in turn leading to different herbal remedy needs. In addition, unequal access to means of transport causes inequitable distribution of resources (Cerqueira, 2017).…”

ZIKA Virus infection in pregnant women in French Guiana: More precarious-more at risk

“…This epidemic spread to neighboring French Guiana in 2016, but until now there was no study of the impact of poverty on the prevalence of infection. In order to deal with the important proportion of asymptomatic Zika virus (ZIKV) infections [6] and a risk of delayed access to medical care in poor populations, [7,8] ZIKV serology was recommended at each trimester for all seronegative pregnant women. A first analysis of data collected during the 4 first months of the outbreak provided a representative picture of the spectrum of disease of ZIKV infection in pregnant women and mapped the intensity of the epidemic throughout French Guiana [6], however it did not look at specific subpopulations of pregnant women.…”

Palliative Care and Socio-Cultural Interactions in French Guiana: A Case Report and Discussion

“…Late diagnosis, advanced stage at diagnosis, difficulties in accessing treatment facilities, and absence of prevention and screening are common problems in tropical countries which generally are of low and middle-low income [5][6][7][8][9]. Surprisingly this is also the case for a large proportion of the population in French Guiana [10].…”