Background

Acute fever is a symptom of illness most often associated with an infectious disease occurrence, sometimes leading to admission to clinics or hospitals. However, as diagnostic tests are not widely available, diagnosis of the cause of fever is commonly based on clinical judgement without laboratory confirmation. Patient judgement of that illness is also involved in its outcome, deferring the seeking of treatment until deciding that attention is needed.

Consequently, patients may become very ill before being seen at the clinic and receive inadequate or improper treatment for an infection of unknown identity. Patient judgement of the need for care with a febrile illness may hinge upon the difficulty of obtaining that care. Understanding distance to care and illness triggers to seeking care may aid in delivery strategies that may more effectively curb death due to acute febrile illnesses.

This research aims to assess the impact of distance to healthcare on the threshold of illness and its role in triggering the seeking of medical assistance for febrile illness at an isolated and impoverished site in eastern Indonesia. Although distance is understood as a geographical and socioeconomic determinant of healthcare-seeking decisions and illness outcomes, no studies in Indonesia have yet examined thresholds of illness prompting the decision to seek medical assistance with respect to distances needed to cross.

Objectives

1. Assess the diversity of infectious agents causing AFI in Indonesia;
2. Understand the language and perception of acute febrile illness in Abui context;
3. Conduct a demographic survey with geolocation for randomization and analysis;
4. Identify and characterize the triggers of health-seeking behaviour, and;
5. Examine those triggers and ease of access to health care.

Study Design

This study involves

1. A systematic review on acute febrile illness and treatment-seeking behaviour related to fever,
2. An ethnographic study to capture the heterogeneity of the population and the social construction of fever and fever experience,
3. Demographic mapping for sample size and household selection, and
4. Socio-demographic survey to detect the association between distance from home to the nearest health facility and scale of illness.