Article Text

Download PDFPDF

How patients’ experiences of respiratory tract infections affect healthcare-seeking and antibiotic use: insights from a cross-sectional survey in rural Anhui, China
  1. Mengjie Diao1,
  2. Xingrong Shen1,
  3. Jing Cheng1,
  4. Jing Chai1,
  5. Rui Feng2,
  6. Panpan Zhang1,
  7. Rongyao Zhou1,
  8. Helen Lambert3,
  9. Debin Wang1
  1. 1 School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
  2. 2 Library Department of Literature Retrieval and Analysis, Anhui Medical University, Hefei, Anhui, China
  3. 3 Department of Population Health Sciences, University of Bristol, Bristol, UK
  1. Correspondence to Dr Debin Wang; dbwang{at}


Objective To investigate the occurrence of reported respiratory tract infection (RTI) symptoms and their effects on use of self and professional care among patients in the community.

Design A cross-sectional retrospective household survey.

Setting 12 administrative villages from rural Anhui, China.

Participants 2160 rural adult residents aged ≥18 years registered as rural residents and actually living in the sampled villages when this study was conducted.

Method The respondents were recruited using stratified-clustered randomised sampling. A structured questionnaire was deployed to solicit information about social demographics, symptoms of last RTI and healthcare-seeking following the RTI. Descriptive analyses were performed to investigate the reported symptoms, and multivariate logistic regression models were developed to identify relationships between number of concurrent symptoms and healthcare-seeking and antibiotics use.

Results A total of 1968 residents completed the survey, resulting in a response rate of 91.1%. The number of concurrent symptoms showed a clear increasing trend with seeking help from clinics and being prescribed antibiotics. Multivariate regression revealed statistically significant associations between the following: (a) visiting clinics and education (OR=0.790), sore throat (OR=1.355), cough (OR=1.492), shortness of breath (OR=1.707) and fever (OR=2.142); (b) buying medicine from shops without prescription and education (OR=1.230) and cough (OR=1.452); (c) getting antibiotics at clinics and sore throat (OR=2.05) and earache and/or tinnitus (OR=4.884); and (d) obtaining antibiotics at medicine shops and productive cough (OR=1.971).

Conclusions Reported RTI symptoms play an important role in shaping both patient- and doctor-led responses.

  • respiratory tract infection
  • antibiotics
  • rural residents
  • healthcare-seeking

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from


  • Contributors MD participated in data collection and drafted the manuscript. XS and RF designed the instruments and performed data analysis. JChe and JCha implemented field data collection, trained data collectors and controlled data quality. RZ and PZ implemented the data collection. DW provided expertise for overall design of the study and revised and finalised the manuscript. HL contributed to the interpretation of data and revised and finalised the manuscript. All authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was supported partly by China–UK Prosperity Fund (grant number PPYCHN1590/15SS19) and partly by the National Natural Science Foundation of China and the Medical Research Council of the UK (grant numbers 81661138001 and 71704003).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study protocol was reviewed and approved by the Biomedical Ethics Committee of Anhui Medical University (reference number: 201500800) prior to the study commencing.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Anonymised participant data used in the preparation of this article will be made available on request to the lead author.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.