Determinants of orthopaedic service utilisation among young people aged 5-24 years old in Zambia

Abstract

Musculoskeletal conditions and/or disorders (MSDs) are the main causes of disability in many patients even though such disorders can be addressed through orthopaedic care. Some of the known factors that influence the utilisation of Orthopaedic services utilisation include: geographical coverage, availability of human resources, client socioeconomic and demographic characteristics among others. However, the actual levels of Orthopaedic services utilisation with their associated factors in Zambia remain unknown to a larger extent. Most research in orthopaedics in Zambia has focussed mainly on pure clinical research yielding little information on determinants of Orthopaedic services utilisation. This study examined, with a conceptual based multidimensional model, the determinants of Orthopaedic service utilisation among young patients (5-24) at the University Teaching Hospital and the St John Paul II Orthopaedic Mission Hospital in Lusaka, Zambia. An embedded mixed methods design was used to conduct a hospital based cross sectional study that focused on high and low level of orthopaedic services utilisation. Stratified random sampling was used to draw a sample of 162 children and young people (5-24) from the hospital registers. Purposive sampling was used for eight Service providers and 10 parents. Quantitative data was collected using a data extraction checklist and self-administered questionnaires for service providers. These contained questions on service attributes and client characteristics. Qualitative data was collected using a semi structured interview guide for interviews with parents. A focus group discussion guide was used to hold one focus group discussion with six clients aged 15 to 24. Quantitative data was analysed using STATA Version 14. Statistical tests included chi square, univariate and multiple logistic regression. Thematic and content analysis was done for qualitative data. The study found that the proportion for high level of use was 41%. The determinants included type of service, where clients from physiotherapy less likely to use services compared to clients from prosthetic and orthotics workshops [AOR 0.16, 95% CI 0.05, 0.59; P=0.01]; Area of residence, where clients aged 5-24 living in low density residential areas were less likely to use Orthopaedic services compared to those in high density residential areas [AOR 0.14, 95% CI 0.05, 0.43; P=0.0001]. Health Insurance was another determinant in which those without Insurance were less likely to use Orthopaedic services compared to those with Insurance[ AOR 0.17 95% CI 0.05, 0.55; P=0.003]. At service level, limited financial and human resources hindered the hospitals from achieving all their objectives. There are referrals /consultations within the hospitals. However, there is little or no coordination in form of a referral network. Most parents did not understand the cause of their child’s MSDs and a few were hopeful that better outcomes would ensue. Key barriers cited by most mothers included lack of information about practices and other essential health actions to manage MSDs at home; cultural beliefs; distance to health facility and costs of transport and fear of marital discord if they discussed matters at length with their husbands. In conclusion, the study established that those living in low density residential areas and not having some level of Health Insurance were less likely to use Orthopaedic services. Inadequate resources are major barriers to orthopaedic service provision and need to be adequately addressed.