Healthcare use for acute gastrointestinal illness in two Inuit communities: Rigolet and Iqaluit, Canada

Abstract

Background: The incidence of self-reported acute gastrointestinal illness (AGI) in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI.

Objectives: This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities.

Design: Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals' self-reported healthcare and over-the-counter (OTC) medication utilization related to AGI symptoms.

Results: In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5-14.4%)]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2-24.7%)]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18-12.4) and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2-15.1) were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills) were significantly associated with increased odds of taking OTC medication.

Conclusions: While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use.

Keywords: Aboriginal health; Indigenous health; Inuit health; Nunatsiavut; Nunavut; gastrointestinal illness; healthcare utilization.

Fig. 1

The estimated annual incidence of acute gastrointestinal illness (case definition: 3 or more loose stools/day and/or vomiting in the past 28 days) for Malta (20), Argentina (21), Quebec (22), Poland (23), China (24), Australia (25), Netherlands (7), Chile (26), Italy (6), Nunavik (27), Cuba (28), Denmark (29), Rigolet (14) and Iqaluit (14).

Fig. 2

A map displaying the 2 partner study communities: Rigolet, Nunatsiavut, and Iqaluit, Nunavut, Canada.

Fig. 3

An overview of acute gastrointestinal illness case counts of primary symptoms, secondary symptoms, and reasons for not seeking healthcare by severity for Rigolet, Nunatsiavut (a), and Iqaluit, Nunavut (b), in September 2012 and May 2013.

Fig. 4

Proportion of cases seeking healthcare for acute gastrointestinal illness (case definition: 3 or more loose stools/day and/or vomiting in the past 28 days) for Netherlands (7), Rigolet, Denmark (29), Quebec (22), Chile (26), Iqaluit, Cuba (28), Argentina (21), Poland (23), Italy (6), China (24) and Malta (20). Note: To compare results to international studies, Rigolet and Iqaluit proportions are based on May survey data (28-day recall) using a stricter case definition (September data are precluded).

Fig. 5

The under-reporting pyramids for acute gastrointestinal illness in Rigolet, Nunatsiavut, in September 2012 and May 2013, and for Iqaluit, Nunavut, in September 2012 and May 2013.