Non-communicable diseases and public health facility utilization: a study in rural Kerala

Devi Nair, Krishnanunni Raveendran


Background: The burden of non-communicable diseases increased significantly in India and Kerala carries the highest burden among Indian states. People with chronic non-communicable diseases (NCDs) are particularly vulnerable to socioeconomic inequality due to their long-term expensive health care needs. Provision of health services through public health facilities will reduce the health care expenses and will increase NCD care utilization. This study aimed to assess socioeconomic-factors related to public health service utilization among four major non-communicable disease patients in Pathanmthitta district of Kerala.

Methods: A cross-sectional household survey using WHO CSDH frame work conducted among 715 individuals from 3randomely selected panchayaths in Pathanmthitta district, Kerala. Simple frequencies were used to calculate the prevalence of NCDs in the study population. Chi-square test followed by binary logistics regression was applied (using SPSS 21 statistical package) to examine the effects of demographic and socioeconomic variables of NCD respondents on public health utilization.

Results: Among 715 household survey respondents 472 (66%) reported as Non-communicable disease (NCD) patient. The majority (60.5%) of NCD respondents reported using government facility for health care irrespective of their socioeconomic status. Chi-square test analysis, ration card status, age, gender, education, occupation, income and economic dependency show significance (p<0.005). Public health utilization was seen to be high in female (OR=7.1, p=0.000), people with lower education (OR=11.5, p≤0.002) and lower income (OR=4.1, p=0.000). Public health facility utilization reported high among partially depended people (OR=39.8, p=0.000).

Conclusions: Irrespective of their socioeconomic status NCD patients wants to reduce their financial burden of health care through the utilization of public health facilities. A comprehensive health care financing scheme for chronic NCD patients which is crucial to protect most vulnerable groups.


Kerala, Noncommunicable diseases, Public health facility utilization

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