Modelling of the Therapeutic Itinerary of Households in the City of Bukavu

Background: Concerns about the onset of disease in family members usually create a demand for care and initiate action to seek treatment. Decisions are then made and treatment options are explored. This study aims to identify the therapeutic options used by the inhabitants of Bukavu, analyze the therapeutic itineraries of households, identify the determinants of the use of self-medication, modern medicine, traditional medicine and therapeutic prayer, and analyze the expenditures related to the cost of health care. Methods: A cross-sectional study was conducted in June 2014 in the Bukavu health district, with data collected through a questionnaire. The sample size was 250 households with at least one member who had been ill in the 2 weeks prior to the survey. Results: Self-medication was the most widely used treatment option (44%), followed respectively by modern medicine (36.4%), traditional medicine (14.4%) and prayer (5.2%). Traditional medicine as an initial treatment option accounted for less than 15% of households. We also note that 154 out of 250 households (61.6%) used more than one treatment option; the households described made up to 9 different paths from the first to their second treatment option. In 65.6% of cases (101/154), the shift from the first to the second treatment option is consistent with a care-seeking behavior considered 'rational' (i.e. starting from self-medication, progressing to the use of outpatient care offered by a health professional or a primary health care facility, and subsequently to the use of a hospital). The payment system for care costs is regressive, with poorer patients paying the same amounts as richer ones. Conclusions: This study highlights the importance of self-medication as the first and most used treatment option by households in Bukavu, regardless of the nature of the health problem. It is important to rationalize this practice. Although modern medicine is not the initial treatment option for households, it is the last resort for many patients. Household treatment pathways in this urban environment are complex; health managers should try to deal with this reality. Finally, our study indicates that poor patients face the same level of health care cost payments as the rich, hence the need for a better balance in health care financing mechanisms.