Health care seeking behaviour and expenditure pattern among Scrub Typhus patients attending a tertiary care hospital in Mysore city

Rajesh Jayanandan, Renuka Manjunath, Praveen Kulkarni

Abstract


Background: Scrub typhus is one among the re-emerging infectious diseases throughout the world. Various studies conducted across India reveals that its public health importance is increasing. This study was conducted 1) To describe the socio-demographic and epidemiological profile of patients admitted with scrub typhus. 2) To assess the health care seeking behaviour of these patients. 3) To estimate the cost factors incurred in the current episode of illness.  

Methods: This prospective study was conducted from January to December 2013 among all lab confirmed cases of scrub typhus admitted to department of medicine and pediatrics of JSS Hospital, Mysore. The study subjects were interviewed with a pre-tested and structured questionnaire. Data regarding socio-demographic profile, epidemiological profile, disease outcome, health care seeking behaviour and cost factors incurred with current episode of illness were collected. Data entry and analysis were done with SPSS.v.22.0 using descriptive statistics like mean, standard deviations and inferential statistics like chi-square test.

Results: Among 192 patients tested positive by Weil-Felix test and/or Immuno-Chromatographic Test (ICT) for scrub typhus majority 105 (54.7%) were males and were predominantly 135 (70.3 %) from rural areas. Mostly 172(89.6%) were unaware of any mite bite in the past. Majority 167 (87.0%) of them had visited atleast three Health Care Facilities (HCF) for treatment. The mean ± SD total duration of illness was 15.6 ± 4.1 days. Most 104 (54.2 %) of them had suffered from illness for 11-15 days. Majority 175 (91.1%) of them had recovered while 3 (1.6%) of them had succumbed to the condition. The median Total direct cost, total indirect cost and overall total cost were Rs. 7500 (7000-9500), Rs. 3000 (2500-3500) and Rs. 10500 (10000-13000) respectively. Most 104 (54.2%) of them spent from money borrowed from others, followed by 78 (40.6%) spent Out Of Pocket (OOP).

Conclusion: People from rural areas, unskilled workers and children were affected predominantly. With timely diagnosis and appropriate treatment, significant morbidity and mortality could be prevented. Promotion of various public and private health insurance schemes among public would minimise the OOP expenditure and prevents debts.

 


Keywords


Scrub typhus, Health seeking behavior, Health care facilities, Direct cost, Indirect cost, Total cost

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References


Kelly DJ, Fuerst PA, Ching WM, Richards AL. Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin Infect Dis. 2009;48:203-30.

Varghese GM, Janardhanan J, Trowbridge P, Peter JV, Prakash JA, Sathyendra S. Scrub typhus in South India: clinical and laboratory manifestations, genetic variability, and outcome. Int J Infect Dis. 2013;17:e981-7.

Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. 2003;16(5):429-36.

Mahajan SK. Rickettsial diseases. J Assoc Physicians India. 2012;60:37-44.

Mahajan SK, Kashyap R, Kanga A, Sharma V, Prasher BS, Pal LS. Relevance of Weil Felix Test in Diagnosis of scrub typhus in India. J Assoc Physician India. 2006;54:619-21.

Rathi NB, Rathi NA, Goodman MH, Aghai ZH. Rickettsial diseases in Central India: proposed clinical scoring system for early detection of spotted fever. Indian Pediatr. 2011;48:867-72.

Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India. 2010;58:24-8.

Kawoosa Z, Kundal V, Hamid S, Kawoosa N, Gupta B, Kundal S, et al. Clinical profile of ricketssial disease in Jammu (Northern India). Inter J Trop Med Public Health. 2012;1(2):1-31.

Prabhakaran A, Sohan L, Shyamal B, Vinoth S, Asraf Ali S, Veena M. Serological study of rickettsial diseases in human and rodent population in Chittoor Dist. (A.P.). J Commun. Dis. 2010;42(3):209-13.

Lee YS, Wang PH, Tseng SH. Epidemiology of scrub typhus in Eastern Taiwan, 2000-2004. J Infect Dis. 2006;59:235-8.

Walker JS, Chan CT, Manikumaran C, Elisberg BL. Attempts to infect and demonstrate transovarial transmission of R. tsutsugamushi in three species of Leptotrombidium mites. Ann N Y Acad Sci. 1975;266:80-90.

Singh SP, Singh R, Ahmad N. A study of complications of scrub typhus in a tertiary health care institute of Utarakhand, India. Int J Res Med Sci. 2014;2:246-9.

Subbalaxmi MVS, Madisetty MK, Prasad AK, Teja VD, Swaroopa K, Chandra N, et al. Outbreak of scrub typhus in Andhra Pradesh - experience at a tertiary care hospital. J Assoc Physicians India. 2014;62:1-7.

Subbalaxmi MVS, Chandra N, Teja VD, Lakshmi V, Rao MN, Raju YSN. Scrub typhus-experience from a South Indian tertiary care hospital. BMC Infect Dis. 2012;12(1):77.

Mittal V, Gupta N, Bhattacharya D, Kumar K, Ichchupujani RL, Singh S, et al. Serological evidence of rickettsial infections in Delhi. Indian J Med Res. 2012;135(4):538-41.

Girija S, Rajan A, Sathiyanarayanan J, Mangaiyarkarasi T, Saban P, Sunil S, et al. Scrub typhus - an emerging disease in South India. Indian J Res Rep Med Sci (IJRRMS). 2013;3(4):11-3.

Udayan U, Dias M, Machado S. A hospital based study of rickettsial diseases evidenced by Weil Felix test in a tertiary care hospital. CHRISMED J Health Res. 2014;1:150-3.

Prakash A, Acharya AS, Jain N, Bhattacharya D, Chhabra M. Scrub typhus - an emerging public health problem in Delhi. Indian J Med Special (IJMS). 2014;5:1-7.

Palanivel S, Nedunchelian K, Poovazhagi V, Raghunadan R, Ramachandran P. Clinical profile of scrub typhus in children. Indian J Pediatr. 2012;79(11):1459-62.

Mahajan SK. Scrub typhus. J Assoc Physician India. 2005;53:954-8.

Chambers R. Rural development: putting the last first. In: Chambers R, eds. A Book. 1st ed. London: Longman; 1983.

Whitehead M, Dahlgreen G, Evans, T. Equity and health sector reforms: Can low income countries escape the medical poverty trap? Lancet. 2001;358:833-6.

Heijink R, Xu K, Saksena P, Evans D. Validity and comparability of out-of-pocket health expenditure from household surveys: a review of the literature and current survey instruments. In: Heijink R, Xu K, Saksena P, Evans D, eds. WHO Review. Geneva: World Health Organization; 2011.

Raban MZ, Dandonaa R, Dandonaa L. Variations in catastrophic health expenditure estimates from household surveys in India. Bull World Health Organ. 2013;91:726-35.

Chowdhury S. Health shocks and the urban poor: a case study of slums in Delhi. In: Chowdhury S, eds. 5th Annual Conference on Economic Growth and Development. New Delhi: National Institute of Public Finance and Policy; 2009.