Choice of health providers and health seeking behavior among forest goer population in Myanmar: Findings from a cross-sectional household survey

Abstract BackgroundIn Myanmar, malaria still poses a significant burden for vulnerable populations particularly forest goers even though impressive progress has been made over the past decade. Limited evidence existed related to forest goers’ health seeking behavior and factors that drive decision making for providers’ choice to support national malaria programs towards elimination. In response to that, this research is conducted to identify who they prefer and what are the factors associated with providers’ choice in malaria febrile illness and Rapid Diagnostic Testing (RDT).MethodsA cross-sectional study applying quantitative household survey was completed with 479 forest goer households in 20 malaria endemic townships across Myanmar. The study collected household data together with the types of providers that they consulted for recent and previous febrile episodes. To identify the factors associated with providers’ choices, univariate and multivariate multinomial logistic regressions were done using Stata version 14.1. Statistical significance was set as p= 0.05.ResultsA total of 307 individuals experienced fever within one month and 72.3% sought a care from providers. And a total of 509 forest goers reported that they had a previous febrile episodes and 62.6% received care from a provider. Furthermore, 56.2% said that they had RDT testing during these previous febrile illnesses. They consulted public facilities and public health staff, private facilities, private and semi-private providers, community health volunteers or workers in their residing village and those located outside their village but majority prefer those within their village. On multivariate analyses, second richest quintile (Public, RRR=12.9) (semi-private, RRR=17.9), (outside, RRR=8.4) and, access to 4 and above nearby providers (Public, RRR=30.3) (semi-private, RRR=1.5) (outside, RRR=0.5) were found to be significantly associated with provider choice for recent fever episode. Similar findings were also found for previous febrile illness and RDT testing among forest goers. ConclusionThe study highlighted that in forest goer households, they preferred nearby providers and the decision to choose providers seemed to be influenced by their access to number of nearby providers and socio-economic status when they sought care from a provider regardless of fever occurrence location. It is important that the national programs consider involving these nearby providers in elimination efforts.