Abstract

Bakeera S. K.1,2*, Petzold M.3 , Pariyo G. W. 1 , Galea S.4 , Tomson G.2 and Wamala S.2,5

Evidence mainly from high and middle income countries shows that community social capital is associated with positive health outcomes. The current policy interest in social capital stems from the anticipation that investing in it will enhance improvements in population health and some governments in high income countries have promoted initiatives to enhance its generation. However, there is a paucity of empirical evidence from low income countries on the utility of social capital for health outcomes. Therefore, the study objective was to assess the role of social capital in the use of health care services in Uganda, a low income country. The study sample included nine hundred and thirty six febrile children with complete data on place of treatment, caregiver social capital and socio-demographic variables; child demographic variables and household socioeconomic status were selected from the Iganga-Mayuge Health and Demographic Surveillance Site data base. The association for each dimension of social capital and use of a public health facility was explored using bivariate and multivariable regression models, controlling for potential confounding factors and other social capital variables at the individual caregiver and community levels. The study found that high levels of trust (OR 2.75, 1.50 to 5.02) and medium levels of informational support (OR 1.68, 1.12 to 2.50) were positively associated with the use of a public health facility. In contrast, high levels of reciprocity (OR 0.69, 0.49 to 0.97) were associated with non- use of a public health facility. This exploratory study shows an independent effect of community social capital on treatment choices made by child caregivers in a predominantly rural area of a low income country. This observation places social capital amongst the other contextual level factors that influence use of health care services in this setting. Such information can be used retrospectively or prospectively by health planners to enhance the response of communities to new policies and strategies.