Research

Access to health care in relation to socioeconomic status in the Amazonian area of Peru

Charlotte Kristiansson¹ , Eduardo Gotuzzo² , Hugo Rodriguez³ , Alessandro Bartoloni⁴ , Marianne Strohmeyer⁴ , Göran Tomson¹ and Per Hartvig⁵

¹  IHCAR (Div International Health), Karolinska Institutet, Stockholm, Sweden

²  Inst Med Trop A von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru

³  Health Directorate of Loreto, Iquitos, Loreto, Peru

⁴  UFDID, University of Florence, Florence, Italy

⁵  Dept Pharmacology and Pharmacotherapy, Farma, University of Copenhagen, Denmark

author email corresponding author email

International Journal for Equity in Health 2009, 8:11doi:10.1186/1475-9276-8-11

Published:	15 April 2009

Abstract

Background

Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drugs in relation to household socioeconomic status for children in two small Amazonian urban communities of Peru; Yurimaguas, Department of Loreto and Moyobamba, Department of San Martin, Peru.

Methods

Cross-sectional study design included household interviews. Caregivers of 780 children aged 6–72 months in Yurimaguas and 793 children of the same age in Moyobamba were included in the study. Caregivers were interviewed on health care seeking strategies (public/private sectors; formal/informal providers), and medication for their children in relation to reported symptoms and socio-economic status. Self-reported symptoms were classified into illnesses based on the IMCI algorithm (Integrated Management of Childhood Ilness). Wealth was used as a proxy indicator for the economic status. Wealth values were generated by Principal Component Analysis using household assets and characteristics.

Results

Significantly more caregivers from the least poor stratum consulted health professionals for cough/cold (p < 0.05: OR = 4.30) than the poorest stratum. The poorest stratum used fewer antibiotics for cough/cold and for cough/cold + diarrhoea (16%, 38%, respectively) than the least poor stratum (31%, 52%, respectively). For pneumonia and/or dysentery, the poorest used significantly fewer antibiotics (16%) than the least poor (80%).

Conclusion

The poorest seek less care from health professionals for non-severe illnesses as well as for severe illnesses; and treatment with antibiotics is lacking for illnesses where it would be indicated. Caregivers frequently paid for health services as well as antibiotics, even though all children in the study qualified for free health care and medicines. The implementation of the Seguro Integral de Salud health insurance must be improved.