Patterns of Healthcare Utilisation for Low Back Pain: A Population-based Study in Ethiopia

Getahun Kebede Beyera, PhD Candidate, School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia; Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; Jane O’Brien, PhD, School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia; Steven Campbell, PhD, Professor, School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia

Abstract

Background

Low back pain (LBP), which is the leading cause of years lived with disability worldwide, remains one of the major public health problems. Epidemiological studies have shown that both the prevalence and associated impact of LBP will increase, in the coming years due the predicted aging of the world’s population, which will largely occur in developing countries, such as those in sub-Saharan Africa. Appropriate and timely healthcare utilisation are suggested to reduce the long-term impact of the pain to individuals and healthcare systems. However, epidemiological data on health care utilisation for optimal management of LBP are lacking due to more pressing problems, such as infectious diseases, to which attentions and the majority of health resources are channelled. Therefore, this study aimed at investigating patterns of health care utilisation for LBP in the general population of Ethiopia.

Methods

A population based cross-sectional study was conducted in South-West Shewa zone of Ethiopia from June to November 2018. The data were collected by interviewing adults with LBP (n=1812, randomly selected) using a psychometrically tested and validated instrument, analysed using R version 3.5.1. A log-binomial regression model was used to determine the Prevalence Ratio (PR) with a 95% confidence interval (CI) in identifying factors associated with health care utilisation for LBP. Estimates of population parameters were also presented with 95% CIs and p-values. For all applications of inferential statistics, a p-value of < 0.05 was taken as the significance level.

Results

The lifetime prevalence of health care utilisation for LBP was 36.1%, 95% CI: 33.9-38.1, while the annual prevalence rate was 30%, 95% CI: 27.9-32.2. Of those with a one-year history of health care utilisation, while 7.4%, 95% CI: 4.9-10.3 rural and 36.6%, 95% CI: 29.5-44 urban populations utilised health care from general hospitals, 1.4%, 95% CI: 0.3-2.7 rural and 6.8%, 95% CI: 3.1-10.8 urban populations utilised health care from specialised hospitals. Several socio-demographic factors, modifiable health behaviours/lifestyle habits, pain interrelated factors, and specific factors such as beliefs about the pain, depressive symptoms and insomnia were associated with health care utilisation for LBP.

Conclusions

There were potential inequalities between urban and rural populations in accessing the health care system with relatively better services. The implications of this research are that it may be prudent for the Ethiopian health care policy makers to develop the necessary strategies to meet the health needs of both urban and rural populations with LBP.

Keywords: Low back pain; Pattern; Health care utilisation; Population-based; Cross-sectional study