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Abstract：
BACKGROUND: Fever is a common reason to seek healthcare in Southeast Asia, and the decline of malaria has complexified how is perceived, and what actions are taken towards it. We investigated the concept of fever and the determinants influencing health-seeking behaviours among migrants on the Thai-Myanmar border, where rapid economic development collides with precarious political and socio-economic conditions.
METHODS: We implemented a mixed-methods study between August to December 2019. Phase I used a qualitative approach, with in-depth interviews and focus group discussions. Phase II used a quantitative approach with a close-ended questionnaire based on Phase I findings. A conditional inference tree (CIT) model first identified geographic and socio-demographic determinants, which were then tested using a logistic regression model.
RESULTS: Fever corresponded to a high diversity of conceptions, symptoms and believed causes. Self-medication was the commonest behaviour at fever onset. If fever persisted, migrants primarily sought care in humanitarian cost-free clinics (45.5%, 92/202), followed by private clinics (43.1%, 87/202), health posts (36.1%, 73/202), public hospitals (33.7%, 68/202) and primary care units (30, 14.9%). 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 and public hospital attendance (aOR 2.56, 95% CI [1.00-6.54] and 5.15, 95% CI [1.80-14.71], respectively).
CONCLUSIONS: Fever conception and believed causes are context-specific and should be investigated prior to any intervention. Distance to care and legal status were key determinants influencing health-seeking behaviour. Current economic upheavals are accelerating the unregulated flow of undocumented migrants from Myanmar to Thailand, warranting further inclusiveness and investments in the public health system.
METHODS: We implemented a mixed-methods study between August to December 2019. Phase I used a qualitative approach, with in-depth interviews and focus group discussions. Phase II used a quantitative approach with a close-ended questionnaire based on Phase I findings. A conditional inference tree (CIT) model first identified geographic and socio-demographic determinants, which were then tested using a logistic regression model.
RESULTS: Fever corresponded to a high diversity of conceptions, symptoms and believed causes. Self-medication was the commonest behaviour at fever onset. If fever persisted, migrants primarily sought care in humanitarian cost-free clinics (45.5%, 92/202), followed by private clinics (43.1%, 87/202), health posts (36.1%, 73/202), public hospitals (33.7%, 68/202) and primary care units (30, 14.9%). 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 and public hospital attendance (aOR 2.56, 95% CI [1.00-6.54] and 5.15, 95% CI [1.80-14.71], respectively).
CONCLUSIONS: Fever conception and believed causes are context-specific and should be investigated prior to any intervention. Distance to care and legal status were key determinants influencing health-seeking behaviour. Current economic upheavals are accelerating the unregulated flow of undocumented migrants from Myanmar to Thailand, warranting further inclusiveness and investments in the public health system.
摘要：
背景：发烧是在东南亚寻求医疗保健的常见原因，疟疾的下降使人们的看法变得更加复杂，以及对它采取了什么行动。我们调查了发烧的概念以及影响泰缅边境移民寻求健康行为的决定因素，在那里，快速的经济发展与不稳定的政治和社会经济条件相冲突。
方法：我们在2019年8月至12月之间实施了一项混合方法研究。第一阶段采用了定性的方法，深入访谈和焦点小组讨论。第二阶段使用定量方法，并根据第一阶段的调查结果进行封闭式问卷调查。条件推理树(CIT)模型首先确定地理和社会人口统计学决定因素，然后使用逻辑回归模型进行测试。
结果：发烧与概念的高度多样性相对应，症状和相信的原因。自我药物治疗是发烧时最常见的行为。如果发烧持续，移民主要在人道主义免费诊所寻求护理(45.5%，92/202），其次是私人诊所(43.1%,87/202），卫生站(36.1%，73/202），公立医院（33.7%，68/202）和初级保健单位（30，14.9%）。定性分析确定了距离和法律地位是获得医疗保健的主要障碍。定量分析进一步调查了影响健康寻求行为的决定因素：居住在一个免费诊所经营的城镇附近与在卫生站寻求护理成反比（调整后的优势比[aOR]，0.40，95%置信区间[95%CI][0.19-0.86])，和公立医院出勤率（aOR0.31，95%CI[0.14-0.67]）。住在离最近城镇更远的地方与卫生站的出勤率有关（每1公里aOR1.05，95％CI[1.00-1.10]）。具有法律地位与免费诊所出勤率成反比(aOR0.27，95%CI[0.10-0.71])，与私人诊所和公立医院就诊呈正相关(aOR2.56，95%CI[1.00-6.54]和5.15，95%CI[1.80-14.71]，分别)。
结论：发热的概念和相信的原因是特定的背景，应在任何干预之前进行调查。与护理的距离和法律地位是影响寻求健康行为的关键决定因素。当前的经济动荡正在加速无证移民从缅甸到泰国的无管制流动，保证公共卫生系统的进一步包容性和投资。
方法：我们在2019年8月至12月之间实施了一项混合方法研究。第一阶段采用了定性的方法，深入访谈和焦点小组讨论。第二阶段使用定量方法，并根据第一阶段的调查结果进行封闭式问卷调查。条件推理树(CIT)模型首先确定地理和社会人口统计学决定因素，然后使用逻辑回归模型进行测试。
结果：发烧与概念的高度多样性相对应，症状和相信的原因。自我药物治疗是发烧时最常见的行为。如果发烧持续，移民主要在人道主义免费诊所寻求护理(45.5%，92/202），其次是私人诊所(43.1%,87/202），卫生站(36.1%，73/202），公立医院（33.7%，68/202）和初级保健单位（30，14.9%）。定性分析确定了距离和法律地位是获得医疗保健的主要障碍。定量分析进一步调查了影响健康寻求行为的决定因素：居住在一个免费诊所经营的城镇附近与在卫生站寻求护理成反比（调整后的优势比[aOR]，0.40，95%置信区间[95%CI][0.19-0.86])，和公立医院出勤率（aOR0.31，95%CI[0.14-0.67]）。住在离最近城镇更远的地方与卫生站的出勤率有关（每1公里aOR1.05，95％CI[1.00-1.10]）。具有法律地位与免费诊所出勤率成反比(aOR0.27，95%CI[0.10-0.71])，与私人诊所和公立医院就诊呈正相关(aOR2.56，95%CI[1.00-6.54]和5.15，95%CI[1.80-14.71]，分别)。
结论：发热的概念和相信的原因是特定的背景，应在任何干预之前进行调查。与护理的距离和法律地位是影响寻求健康行为的关键决定因素。当前的经济动荡正在加速无证移民从缅甸到泰国的无管制流动，保证公共卫生系统的进一步包容性和投资。
