This is the first study on the burden of, and the healthcare-seeking behavior for, RI conducted in Laos. The prevalence of RI in the survey was higher than the prevalence of influenza in rural Thailand (2.2%)
 and might have been higher if the survey had been carried out during the winter. The Lao national health survey in 2000 revealed that ~ 1% of children under-five had had acute respiratory infection in the two weeks before the survey
. Indoor air pollution (i.e. a very smoky environment inside the household) was a significant risk factor for the high prevalence of RI found in the present study. Many households, particularly in rural areas, used firewood/charcoal for cooking inside their houses, some of which had only a single room. The proportion of persons with RI in the present survey was significantly higher in rural than in peri-urban areas, probably due to the younger age of the study population and the poorer socioeconomic, environmental and hygienic conditions in the rural areas, a finding that is consistent with previous studies
[8–11]. Childhood immunization coverage, which is usually higher in peri-urban than in rural areas, may also play an important role in reducing the risk of respiratory illness among peri-urban people.
About two-thirds of the people with RI in this study sought treatment, which was a high proportion but similar to that found in previous studies from Sri Lanka, Nigeria, Bangladesh, and Uganda
[12–16]. In the Lao national health survey in 2000, only 47% of people who had suffered from any illnesses in the two weeks preceding the survey had sought care
. Whether sick people seek care depends on disease severity, distance from home to healthcare facilities, availability of care services, and affordability. Severity of illness could not explain the high percentage of healthcare-seeking in the present study because only 6% of sick persons were classified as having severe disease and the proportion of ill people who sought care was similar among those who had mild, moderate, and severe disease. The high rate of healthcare-seeking of people in the present study might be due to the availability of healthcare services close to their own homes i.e. in their own village. In the national health survey in 2000, the reasons for not seeking care given by the villagers were mild illness, lack of transport, long distance, and cost
. The reasons for not seeking care in our survey were inability to afford treatment, transportation, and a perception that their illness was mild. The reasons for not seeking care amongst sick persons in our study were totally different from those in a study from the Dominican Republic, where the most frequent reasons were distrust of the clinic staff, shortage of medicines, and dispersion of the rural population
The results of our exploratory study indicate the important role of self-treatment for RI, particularly in rural areas where the accessibility, availability and affordability of healthcare facilities are limited. The reasons for self-treatment were convenience (proximity), cheapness (affordability), and because the illness was mild (severity). The option of self-treatment as the first choice is usually influenced by the perception of severity. The FGD participants in both peri-urban and rural areas reported that they chose self-medication and self-treatment as first line approach in cases of mild RI. In previous studies it was also found that self-treatment was common when the severity of the illness was perceived to be low
[18–20]. In Laos, approximately one third to a half of people self-medicate when they become sick
[4, 21] – findings that are consistent with those of our study. In Guatemala, about two thirds of children with diarrhea and RIs were self-treated by their guardians or relatives and only one third of illnesses were treated by healthcare providers such as pharmacists, doctors, and staff at health posts and centres
A study in the Dominican Republic demonstrated that the choice of health service utilization among caregivers of children with RI was determined by location (proximity) and cost
. Healthcare-seeking behavior in the current survey was very different between peri-urban and rural areas. If there was no improvement following self-treatment, people in peri-urban area preferred to choose private clinics and pharmacies as their next treatment option, while those in rural areas frequently consulted the village health volunteer and visited the health centre. This may be explained by the difference in the availability and proximity of the healthcare facilities between the two areas. In peri-urban areas, private clinics and pharmacies are readily available and nearby when compared with rural areas. In contrast, hardly any private clinics and pharmacies are available in rural areas, apart from the health centre and village health volunteer. It is obvious that Lao villagers prefer to use the closest healthcare facilities because of the convenience and the low travel cost. The national health survey in 2000 also showed that more people in peri-urban and urban areas went to a pharmacy when they were ill compared with those in rural areas
. A study in western Nepal revealed that almost half of episodes of childhood illness were treated by pharmacists and in 15% of episodes medicines were purchased from pharmacies without consultation
Severity of illness is an important determinant of treatment-seeking behavior
[24, 25]. In our study, the decision to move from one healthcare provider to another, or from self-treatment to seeking some form of treatment, was also influenced by severity of illness or treatment failure. Sick persons did not go back to the same healthcare provider or facility which they had originally visited but to other places. In peri-urban areas, people would seek further care in central hospitals, where a better quality of service and modern technology are available. In rural areas, people would like to seek further treatment in the district or provincial hospital, but are constrained from doing so by distance and cost.
The limitations of this study are that the definition of RI used here included only fever with cough and/or sore-throat – symptoms which do not cover many other respiratory illnesses. Another drawback is that the study relied only on self-reporting illness in the previous 30 days, which may be subject to recall and reporting bias. The study was conducted only in a cross-sectional manner in time, and therefore the proportion of RI found in this survey may not be representative of all times of year, especially the winter.