Less Than One-Third of Caretakers Sought Formal Health Care Facilities for Common Childhood Illnesses in Ethiopia: Evidence from the 2011 Ethiopian Demographic Health Survey

Multilevel analysis of factors associated with untreated diarrhea among under five children in Ethiopia using Ethiopian demographic and health survey

Diarrhea refers to the abrupt onset of three or more loose or liquid stools per day. It is the second leading cause of death in infants worldwide. It is an endemic disease and continues to be a serious threat to children in Ethiopia. Despite being a condition that may be prevented, diarrhea can have a negative impact on a child's health. Also, studies have not been able to explore the role of socio-economic characteristics in hindering the treatment. Therefore, this study aimed to explore socio-economic factors that influence treatment of childhood diarrhea. Secondary data analysis was conducted based on the demographic and health surveys data conducted in Ethiopia. A total weighted sample of 1227 under-five children was included for this study. Mixed-effect binary logistic regression analysis was done to identify associated factors of untreated diarrhea. Adjusted Odds Ratio with 95% CI was used to declare the strength and significance of the association. Prevalence of untreated diarrhea among under five children in Ethiopia was 57.32% (95% CI 54.52-60.06%). In the mixed-effect analysis; Children aged 6-11, 12-23, and 24-35 (AOR 0.384, 95% CI 0.187-0.789), 71% (AOR 0.29, 95% CI 0.149-0.596), and 51% (AOR 0.49, 95% CI 0.238-0.995). Children from family number six and above (AOR 1.635, 95% CI 1.102-2.426). Children from middle wealth of family (AOR 1.886, 95% CI 1.170-3.3040). Children from a community with high level of uneducated (AOR 2.78, 95% CI 1.065-3.442) were significantly associated with untreated diarrhea. The prevalence of untreated diarrhea among under-five children in Ethiopia is high. Age of child, family number, household wealth, and community-level educational status were significantly associated with untreated diarrhea among under-five children in Ethiopia. Hence, increasing community educational status, boosting the economic status of the community, and family planning for the community should get due attention.

Individual and community level factors associated with medical treatment-seeking behavior for childhood diarrhea among the Gambian mothers: evidence from the Gambian demographic and health survey data, 2019/2020

INTRODUCTION

In less developed countries, including the Gambia, childhood diarrhea is one of the leading causes of serious illness and death among children. Studies on wider determinants of behaviors in medical treatment seeking for diarrheal illnesses in poor resource settings are limited. However, the challenges are continuing and, there is a gap in research work about it in the Gambia. Therefore, the rationale of this study was to assess the individual and community level factors of medical treatment-seeking behaviors for childhood diarrhea among mothers in the Gambia.

METHODS

Data from the 2019-20 Gambia demographic and health survey were used in this study, which was based on secondary data analysis. A total of 1,403 weighted samples of under-five children's mothers were included in the study for diarrhea medical treatment-seeking behaviors. Because of the hierarchical nature of the data, a multi-level logistic regression model was applied to identify individual and community-level factors that may influence mothers' medical treatment-seeking behaviors of diarrhea. Data were analyzed using multilevel logistic regression analysis. In the multivariable multilevel logistic regression analysis, variables were judged significantly linked with medical treatment-seeking behavior of diarrhea if their p-value was less than 0. 05.

RESULTS

Medical treatment-seeking behaviors for diarrhea were discovered in 62.24% (95% CI: 59.67,64.74) of mothers of under five children. Being a female child has shown odds of (AOR = 0.79, (CI 95%: (0.62,0.98)) times less treatment-seeking behavior than the counterparts. Moreover, compared to mothers whose children were of average size, those whose children were smaller, and larger than average at birth were more likely to seek out pediatric medical treatment (AOR = 1.53, 95% CI (1.08-2.16), and (AOR = 1.31, 95% CI (1.01,1.169)) respectively. On the other side, mothers who have exposure to listening to the radio, and heard about oral rehydration have shown an odds of (AOR = 1.34, CI 95%, (1.05,1.72)), (AOR = 2.21, CI 95%, (1.14,4.30)), being from the middle, and rich household wealth have also shown (AOR = 2.15, CI 95%, (1.32,3.51)), and (AOR = 1.92, (CI 95%, (1.11,3.32)), a child with cough, and fever (AOR = 1.44, CI 95%, (1.09,1.89)), and (AOR = 1.73, CI 95%, (1.33,2.25)) were individual-level factors that have shown association statistically with the outcome variable. Similarly, regarding community level factors mothers who had a postnatal checkup, and those from the Kerewan region have revealed more odds of (AOR = 1.48, CI 95%, (1.08,2.02)), and (AOR = 2.99, CI 95%, (1.32,6.78)) times significantly with treatment seeking behavior of mothers respectively.

CONCLUSION

Diarrhea medical treatment-seeking behavior was found low. Hence, it remains among the top public health challenges in the Gambia. Strengthening mothers' healthcare-seeking behavior and skills on home remedies, and childhood illnesses, advocating mass media exposure, assisting financially disadvantaged mothers, and postnatal checkups after delivery will enhance medical treatment-seeking behavior. Furthermore, coordinating with regional states, and designing timely policies and interventions are highly advisable in the country.

Factors associated with healthcare-seeking behavior for symptomatic acute respiratory infection among children in East Africa: a cross-sectional study

Background

Although there has been promising progress in the reduction of child mortality from ARI, the magnitude is high yet, especially in East Africa. Since mothers/guardians decide upon the type and frequency of healthcare services for children, their good healthcare-seeking behavior could prevent acute respiratory infections (ARI) related mortality and morbidity. This study aimed to investigate the pooled prevalence and factors associated with healthcare-seeking behavior of children younger than five years with ARI symptoms by using data from nationally representative surveys of East Africa.

Methods

We analyzed secondary data based on the eleven East African Demographic and Health Survey data. Both Individual and community level variables were considered for this study and a multilevel binary logistic regression model was fitted to identify associated factors of children’s healthcare-seeking behavior for ARI symptoms. STATA V.14 software was used to clean, recode and analyze the data. All variables with a p-value = 0.2 in the bi-variable analysis were considered for the multivariable multilevel analysis. Adjusted OR (AOR) with 95% CI was reported to reveal significantly associated factors in the multivariable multilevel analysis.

Result

The overall prevalence of healthcare-seeking behavior of under-five children for ARI symptoms was 64.4% in East Africa. In the multilevel analysis, the following characteristics were found to be the most important factors of children healthcare seeking behavior for ARI symptoms (P < 0.05): Rural residence [AOR = 0.51, 95% CI (0.37–0.65)], high community level media usage [AOR = 1.63, 95% CI (1.49–1.79)], high community level women education [AOR = 1.51, 95% CI (1.39–1.66)], primary education [AOR = 1.62, 95% CI (1.45–1.82)], secondary education and above [AOR = 1.99, 95% CI (1.71–2.32)], working mother [AOR = 1.33, 95% CI (1.20–1.48)], unmarried women [AOR = 1.15, 95% CI (1.04–1.27)], media access [AOR = 1.43, 95% CI (1.20–1.58)], richest [AOR = 1.39, 95% CI (1.29–1.51)], distance to health facility not a big problem [AOR = 1.11, 95% CI (1.02–1.21)], Place of delivery at health facilities [AOR = 1.77, 95% CI (1.60–1.95)], age of child 7–23 months [AOR = 1.59, 95% CI (1.39–1.82)], age of child 24–59 months [AOR = 1.24, 95% CI (1.09–1.41)] in comparison with children aged 0–6 months, family size > 10 [AOR = 1.53, 95% CI (1.22–1.92)].

Conclusions and recommendations

The overall prevalence of children’s healthcare-seeking behavior for ARI symptoms was found relatively low in East Africa, ARI symptoms were determined by individual-level variables and community-level factors. Targeted interventions are needed to improve socioeconomic and health systems to overcome the problem of acute respiratory infection in children. Special attention is required to empower local health staff and health facilities to provide proper diagnosis and management of ARI cases in East Africa.

Mothers' Care-Seeking Behavior for Common Childhood Illnesses and Its Predictors in Ethiopia: Meta-Analysis

Background

Healthcare-seeking interventions can potentially reduce child mortality; however, many children die in developing countries without reaching a health facility. The World Health Organization reported that 70% of child deaths are related to delay care-seeking. So, this review is aimed at identifying mothers' care-seeking behavior for common childhood illnesses and predictors in Ethiopia.

Methods

Systematic search of studies was done on PubMed, Scopus, Web of Science, institutional repositories, Academic Search Premier, and manually from reference lists of identified studies in the English language up to August 2021. The quality of the studies was evaluated by the Joanna Briggs Institute (JBI) quality appraisal tool for prevalence study. This meta-analysis used the random-effect method using the STATA™ Version 14 software.

Result

Fourteen studies involving 8,031 participants were included in this meta-analysis. After correcting Duval and Tweedie's trim and fill analysis, the overall pooled prevalence of mothers' care-seeking behavior is 60.73% (95% CI: 43.49-77.97), whereas the highest prevalence, 74.80% (95% CI: 62.60, 87.00) and 67.77%(95% CI: 55.66, 79.87), was seen in Amhara region and urban residents, respectively, while the lowest, 36.49% (95% CI: -27.21, 100.18) and 47.80% (95% CI:-15.31, 110.9), was seen in South Nation Nationality Peoples' Regions and among rural residents, respectively. Mothers' educational status (P ≤ 0.001) and mothers' marital status (P ≤ 0.001) were significantly associated with mothers' care-seeking behavior.

Conclusion

Even though children are a vulnerable group, mothers' care-seeking behavior for common childhood illnesses is significantly low. Educational status and marital status were determinants of mothers' care-seeking behavior. So, all responsible bodies should work on the improvement of mothers' care-seeking behavior.

Level of Mothers’/Caregivers’ Healthcare-Seeking Behavior for Child’s Diarrhea, Fever, and Respiratory Tract Infections and Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis

Objective

To assess the pooled prevalence of mothers' or caregivers' healthcare-seeking behavior for childhood diarrhea, fever, and respiratory tract infections and associated factors in Ethiopia. Study Design. Systematic review and meta-analysis.

Methods

Literature searches were conducted through databases (Google Scholar, PubMed, CINHAL, ScienceDirect, HINARI, and gray literatures) from September 1 to 30, 2021, using key terms in accordance with the PRISMA guidelines. The characteristics of the original articles were described using text and tables. Heterogeneity among the reported prevalence of studies was checked by using a heterogeneity χ² test and I² test. Publication bias was examined by performing Egger's correlation and Begg's regression intercept tests at a 5% significant level. A random-effect model was employed to estimate the pooled prevalence of the outcome variable and its determinants in Ethiopia.

Results

Of the total identified studies, 25 studies were included in the review, with a total of 29,993 study participants. The overall pooled prevalence of mothers' or caregivers' health-seeking behavior for childhood diarrhea, fever, and respiratory tract infections was 60.33% (95% CI: 50.14-70.52). The significant factors were residence (AOR = 3.06, 95% CI: 1.11–8.39), wealth index (AOR = 2.18, 95% CI: 1.92-2.48), perceived severity of illness (AOR = 2.7, 95% CI: 1.12–6.51), and knowledge of the illness (AOR = 1.95, 95% CI: 1.37–2.75).

Conclusion

This review suggests that the overall pooled prevalence of mothers' or caregivers' HSB for childhood diarrhea, fever, and respiratory tract infections was 60.33%. Residence, wealth index, perceived severity of illness, and knowledge of the illness by mothers were the significant factors. Therefore, providing interventions by considering the above factors will improve the overall seeking behavior.

Mothers’ health care-seeking behavior and associated factors for common childhood illnesses in Ethiopia: A systematic review and meta-analysis

Objective:

This review is aimed to estimate the pooled prevalence of mothers’ health care-seeking behavior and associated factors in Ethiopia.

Methods:

International databases were systematically searched for studies that were published between 2008 and 2019. Data were extracted in Microsoft Excel 2019 and then exported to STATA version 14 for further analysis. Publication bias was determined by funnel plot, Begg’s test, and Egger’s test. Heterogeneity between the studies was checked by I2 statistic. The pooled proportion was estimated using random-effects meta-analysis model.

Results:

This review and meta-analysis included 14 studies from a total of 581 papers that were screened. The pooled proportion of mothers’ health care-seeking behavior in Ethiopia was 50.24% (95% CI: 37.13%, 63.35%). Health facility distance (OR = 2.07), awareness about common childhood illnesses (OR = 2.06), educational levels (OR = 1.82), and income (OR = 2.07) were significantly associated variables.

Conclusion:

The overall health care-seeking behavior of mothers for common childhood illnesses in Ethiopia is low. Accordingly, educating mothers/caregivers about the importance of health care-seeking behavior and increasing the proximity of health facilities were recommended to improve health care-seeking behavior.

Barriers to seeking timely treatment for severe childhood pneumonia in rural Bangladesh

OBJECTIVE

Delays in seeking medical attention for childhood pneumonia may lead to increased morbidity and mortality. This study aimed at identifying the drivers of delayed seeking of treatment for severe childhood pneumonia in rural Bangladesh.

METHODS

We conducted a formative study from June to September 2015 in one northern district of Bangladesh. In-depth interviews were conducted with 20 rural mothers of children under 5 years with moderate or severe pneumonia. We analysed the data thematically.

RESULTS

We found that mothers often failed to assess severity of pneumonia accurately due to lack of knowledge or misperception about symptoms of pneumonia. Several factors delayed timely steps that could lead to initiation of appropriate treatment. They included time lost in consultation with non-formal practitioners, social norms that required mothers to seek permission from male household heads (eg, husbands) before they could seek healthcare for their children, avoiding community-based public health centres due to their irregular schedules, lack of medical supplies, shortage of hospital beds and long distance of secondary or tertiary hospitals from households. Financial hardships and inability to identify a substitute caregiver for other children at home while the mother accompanied the sick child in hospital were other factors.

CONCLUSIONS

This study identified key social, economic and infrastructural factors that lead to delayed treatment for childhood pneumonia in the study district in rural Bangladesh. Interventions that inform mothers and empower women in the decision to seek healthcare, as well as improvement of infrastructure at the facility level could lead to improved behaviour in seeking and getting treatment of childhood pneumonia in rural Bangladesh.

Determinants of Delayed Treatment-seeking for Diarrheal Diseases among Mothers with under-five Children in North Western Ethiopia, 2020: A case-control Study

BACKGROUND

Delays in seeking timely proper care pay a large number of deaths from diarrhea in children. Timely and appropriate health care seeking in under-five children with diarrhea reduces life-threatening complications. This study aimed to investigate determinants of delayed treatment-seeking for diarrheal diseases among mothers with under-five children.

METHOD

In Debre Markos public health facilities, a facility-based case-control study was conducted among 412 mothers ((137 cases and 274 controls) from September 1 to October 15, 2020. Consecutive sampling was employed to select cases and controls. Data was collected using a semi-structured interviewer-administered questionnaire. Data were entered into Epi- Data version 4.2.1 and exported to STATA version 14 for analysis. Predictors with P-value <0.25 in the bivariable logistic regression model were candidates for multivariable logistic regression. Pvalue <0.05 was used to declare statistical significance. Finally, results were presented in the form of texts and tables.

RESULT

From 412 selected participants, 408 mothers (136 cases and 272 controls) were included. Female children [AOR 1.85(95% CI 1.15-2.98)], Child age < 24 months [AOR 1.64 (95% CI 1.01-2.65)], mothers'/caregivers without formal education [AOR 4.61 (95% CI 2.03-10.44)], poorest wealth index category [AOR 4.24 (95% CI 1.90-9.48)], absence of health insurance [AOR 3.04 (95% CI 1.60-5.78)], and self-medication [AOR 3.6 (95% CI 1.75-7.4)] were determinants of delayed treatment-seeking.

CONCLUSION

Being female, young age, educational status of the mother, lowest wealth index category, self-medication, and absence of health insurance were determinants of delayed treatment-seeking for diarrheal diseases. Preventive care programs should target age, low socioeconomic status, and a low educational class of the mother.

Factors associated with healthcare seeking for childhood illnesses among mothers of children under five in Chad

Background

Poor healthcare-seeking behaviour is a major contributing factor for increased morbidity and mortality among children in low- and middle-income countries. This study assessed the individual and community level factors associated with healthcare-seeking behaviour for childhood illnesses among mothers of children under five in Chad.

Methods

The study utilized data from the 2014–2015 Chad Demographic and Health Survey. A total of 5,693 mothers who reported that their children under five had either fever accompanied by cough or diarrhea or both within the two weeks preceding the survey were included in this study. The outcome variable for the study was healthcare-seeking behaviour for childhood illnesses. The data were analyzed using Stata version 14.2. Multilevel binary logistic regression model was employed due to the hierarchical nature of the dataset. Results were presented as adjusted odds ratios (aOR) at 95% confidence interval (CI).

Results

Out of the 5,693 mothers who reported that their children under five had either fever accompanied by cough, diarrhea or both at any time in the 2 weeks preceding the survey, 79.6% recalled having sought treatment for their children’s illnesses. In terms of the individual level factors, mothers who faced financial barriers to healthcare access were less likely to seek healthcare for childhood illnesses, relative to those who faced no financial barrier (aOR = 0.80, 95% CI = 0.65–0.99). Mothers who reported that distance to the health facility was a barrier were less likely to seek healthcare for childhood illnesses, compared to those who faced no geographical barrier to healthcare access (aOR = 79, 95% CI = 0.65–0.95). Mothers who were cohabiting were less likely to seek healthcare for childhood illnesses compared to married mothers (aOR = 0.62 95% CI = 0.47–0.83). Lower odds of healthcare seeking for childhood illnesses was noted among mothers who did not listen to radio at all, relative to those who listened to radio at least once a week (aOR = 0.71, 95% CI = 0.55–0.91). Mothers who mentioned that their children were larger than average size at birth had a lesser likelihood of seeking childhood healthcare, compared to those whose children were of average size (aOR = 0.79, 95% CI = 0.66–0.95). We further noted that with the community level factors, mothers who lived in communities with medium literacy level were less likely to seek childhood healthcare than those in communities with high literacy (aOR = 0.73, 95% CI = 0.53–0.99).

Conclusion

The study revealed that both individual (financial barriers to healthcare access, geographical barriers to healthcare access, marital status, frequency of listening to radio and size of children at birth) and community level factors (community level literacy) are associated with healthcare-seeking behaviour for childhood illnesses in Chad. The government of Chad, through multi-sectoral partnership, should strengthen health systems by removing financial and geographical barriers to healthcare access. Moreover, the government should create favourable conditions to improve the status of mothers and foster their overall socio-economic wellbeing and literacy through employment and education. Other interventions should include community sensitization of cohabiting mothers and mothers with children whose size at birth is large to seek healthcare for their children when they are ill. This can be done using radio as means of information dissemination.

Barriers to healthcare access and healthcare seeking for childhood illnesses among childbearing women in sub-Saharan Africa: A multilevel modelling of Demographic and Health Surveys

Introduction

The success of current policies and interventions on providing effective access to treatment for childhood illnesses hinges on families’ decisions relating to healthcare access. In sub-Saharan Africa (SSA), there is an uneven distribution of child healthcare services. We investigated the role played by barriers to healthcare accessibility in healthcare seeking for childhood illnesses among childbearing women in SSA.

Materials and methods

Data on 223,184 children under five were extracted from Demographic and Health Surveys of 29 sub-Saharan African countries, conducted between 2010 and 2018. The outcome variable for the study was healthcare seeking for childhood illnesses. The data were analyzed using Stata version 14.2 for windows. Chi-square test of independence and a two-level multivariable multilevel modelling were carried out to generate the results. Statistical significance was pegged at p<0.05. We relied on ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) statement in writing the manuscript.

Results

Eighty-five percent (85.5%) of women in SSA sought healthcare for childhood illnesses, with the highest and lowest prevalence in Gabon (75.0%) and Zambia (92.6%) respectively. In terms of the barriers to healthcare access, we found that women who perceived getting money for medical care for self as a big problem [AOR = 0.81 CI = 0.78–0.83] and considered going for medical care alone as a big problem [AOR = 0.94, CI = 0.91–0.97] had lower odds of seeking healthcare for their children, compared to those who considered these as not a big problem. Other factors that predicted healthcare seeking for childhood illnesses were size of the child at birth, birth order, age, level of community literacy, community socio-economic status, place of residence, household head, and decision-maker for healthcare.

Conclusion

The study revealed a relationship between barriers to healthcare access and healthcare seeking for childhood illnesses in sub-Saharan Africa. Other individual and community level factors also predicted healthcare seeking for childhood illnesses in sub-Saharan Africa. This suggests that interventions aimed at improving child healthcare in sub-Saharan Africa need to focus on these factors.

Determinants of Delayed Treatment-Seeking for Childhood Diarrheal Diseases in Southwest Ethiopia: A Case-Control Study

Background

Although there are low cost and effective interventions to prevent and treat diarrhea, it is one of the leading causes of morbidity and mortality among under-five children in developing countries. Deaths from diarrheal diseases are largely due to lack of prompt seeking of medical care. This study aimed to identify determinants of delayed treatment-seeking for diarrheal diseases among under-five children in Southwest Ethiopia.

Methods

Unmatched case–control study was conducted among 324 under-five children paired with their mothers/caregivers from 1st April to 30th May 2019. Cases were under-five children paired with their mothers/caregivers who sought treatment after 24 hours of the onset of signs and symptoms of diarrheal diseases, and controls were under-five children paired their mothers/caregivers who sought treatment within 24 hours of the onset of signs and symptoms of diarrheal diseases. Consecutive sampling was used, and data were collected through interviews and chart reviews. Multivariable binary logistic regression analysis was performed, and variables with a P-value <0.05 were considered statistically significant.

Results

A total of 324 (162 cases and 162 controls) under-five children paired with their mothers/caregivers were included in this study. Being rural residents (AOR=1.93, 95% CI: 1.13,3.31), children from households with more than two children (AOR=2.05, 95% CI: 1.15–3.66), preferring traditional healers for the treatment of diarrhea (AOR= 4.78, 95% CI: 1.74,13.12), not having television or radio for the households (AOR=2.05, 95% CI: 1.11–3.66), living in more than 10 km from the nearest health facility (AOR=4.80, 95% CI: 2.61–4.83), and perceiving diarrhea can cure without treatment (AOR=2.11, 95% CI: 1.15–3.87) were significant determinants of delayed treatment-seeking.

Conclusion

Being rural residents, larger family size, physical inaccessibility of health facilities, not having access to electronic media (television or radio), preferring traditional healers for the treatment of diarrhea, and having the perception that diarrhea can be cured without treatment were determinants of delayed treatment-seeking for diarrheal diseases among under-five children. Thus, multidimensional approaches that can address accessibility of health facilities and improve caregivers’ awareness are necessary to encourage prompt treatment-seeking for diarrheal diseases among under-five children.

Acute respiratory infection and its associated factors among children under-five years attending pediatrics ward at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: institution-based cross-sectional study

BACKGROUND

Acute respiratory infection is manifested by cough accompanied by short rapid breathing which may be associated with death especially when there are other co-morbidities. From an estimated 5.4 million children under -five years that died in 2017-roughly half of those deaths occurred in sub-Saharan Africa and acute respiratory infection contributed to the highest number of deaths. The current study aimed at evaluating the prevalence of, and risk factors associated with, acute respiratory infection hospitalization in under-five years children hospitalized at the University of Gondar Comprehensive Specialized Hospital.

METHOD

An institution-based cross-sectional study was carried out from May 01/2019 to July 10/2019. After the selection of participants using simple random sampling, face to face interview was performed using a semi-structured pre-tested questionnaire. Data were also extracted from medical registration charts. We used EPI Info 7 for data entry and exported into SPSS 21 for analysis. Results were presented by simple frequency, percentage and mean for descriptive variables. Binary logistic regression analysis was used to test the association of covariates and outcome variable. Variables with a p < 0.2 during the bivariable binary logistic regression analysis were included in the multivariable logistic regression analysis. Variables with p < 0.05 were considered as significantly associated with acute respiratory infection. This study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology guideline.

RESULTS

Four hundred and twenty-two under-five years' children attending the Pediatrics ward were included in this study. The prevalence of acute respiratory infection among under-five years' children in this study was 27.3%. Children aged below 12 months (AOR:3.39, 95% CI: 1.19, 9.65), maternal age of 16 to 27 years (AOR: 1.95, 95% CI: 1.03, 3.70), maternal age of 28 to 33 years (AOR: 2.73, 95% CI: 1.40, 5.34), lack of maternal awareness of handwashing (AOR: 2.79, 95% CI: 1.15, 6.76), rural residence (AOR:2.27, 95% CI: 1.18, 4.39), and lack of meningitis (AOR: 0.22, 95% CI: 0.08, 0.55), were significantly associated with acute respiratory infection.

CONCLUSION

Acute respiratory infection was common among children under-five years. Child and maternal age, residence and maternal hand hygiene information were significant factors identified to be associated with an acute respiratory infection.

Determinants of delay in care seeking for diarrheal diseases among mothers/caregivers with under-five children in public health facilities of Arba Minch town, southern Ethiopia; 2019

Background

Timely and appropriate health care seeking for diarrhea of under-five children is important to reduce severe and life-threatening complications. However, different findings indicate that mothers of under-five children often delay in seeking care which in turn contributes to the death of large number of children without ever reaching a health facility. Therefore, a proper pinpointing of determinants of delay in seeking care informs intervention strategies for health service planners.

Objectives

Of this study was to identify the determinants of delay in care seeking for diarrheal disease among mothers/caregivers of under-five children in public health facilities of Arba Minch town, South Ethiopia, 2019.

Methods

Facility based case control study was conducted from March 4 to April 30, 2019. Total sample size was 400. Cases were selected by systematic random sampling technique while controls were mothers of under-five children with signs and symptoms of diarrhea who came to the same health facility within 24 hours following cases. Data was collected by using pretested structured questionnaire by three data collectors and entered into EpiData V4 and exported to SPSS V23 for further analysis. Bivariable logistic regression was done to identify variables candidate for Multivariable LR at p-value<0.25. Multivariable logistic regression was done and p-value <0.05 and 95%CI of AOR was used to declare statistical significance.

Result

Female sex[AOR = 1.93, (95%CI: 1.11,3.36)], child age <24 months[AOR = 4.47,95%CI:2.51,7.97)], mothers’/caregivers without formal education[AOR = 6.90, (95%CI:3.10,15.37)], and attended primary school [AOR = 3.12,(95%CI:1.44,6.73)], poorest household wealth index category[AOR = 2.81, (95%CI:1.20,6.58) and poor household wealth index category [AOR = 2.61,(95%CI: 1.12, 6.09)], mothers/caregivers who did not visit health facility to first episode diarrhea [AOR = 4.55, (95%CI:2.41,8.59)], mothers/caregivers who were satisfied in the last six month visit [AOR = 0.29, (95%CI:0.15,0.55)], and poor perceived health care professionals respect[AOR = 4.91, (95%CI:2.64,9.15)] were important determinants of delay in seeking care.

Conclusions

Sex and age of the child, educational status of the mother/caregiver, poor wealth index category, not visiting health facility at first response, satisfaction with the care and examination, and respect of health care professionals were important determinants of delay in seeking care among mothers/caregivers of under-five children with diarrhea illness. All concerned body should focus interventions on poor and less educated mothers/caregivers with emphasis on female children and <24 months. Health workers are needed to provide respectful service to promote satisfaction level of clients.

Mothers/caregivers healthcare seeking behavior towards childhood illness in selected health centers in Addis Ababa, Ethiopia: a facility-based cross-sectional study

Background

Seeking healthcare in children is unique since parents decide upon the type and frequency of healthcare services accessed. Mothers/caregivers lower healthcare seeking behavior is one of the major reason for increased morbidity and mortality from childhood illness in developing countries. Hence, this study aimed to assess healthcare seeking behavior of mothers/caregivers towards childhood illnesses in selected health centers of Addis Ababa, Ethiopia.

Methods

A facility-based cross-sectional survey was conducted on 422 sampled mothers/caregivers of children age 0–59 months, from April 18 to May 11, 2016. Ten health centers were selected using simple random sampling technique and proportionate number of participants were included from each health centers. A pre-tested, semi-structured questionnaire was used to collect data. Data were analyzed using SPSS version 20.0. Descriptive statistics was used to summarize socio-demographic characteristics and multivariable logistic regression was employed to identify factors associated with of healthcare seeking behavior.

Result

In case of illnesses, 26.5% of mothers/caregivers sought healthcare for their children. Among the common childhood illnesses, acute respiratory tract infection and diarrhea accounted for 47.6 and 31%, respectively. Mothers/caregivers healthcare seeking behavior towards common childhood illnesses were influenced by child’s age (AOR = 1.78, 95% CI:1.02, 3.13), education of mothers/caregivers (AOR = 4.24, 95% CI:1.32, 13.63), family size (AOR = 3.83, 95% CI:1.06, 13.78), perception of severity of illnesses (AOR = 2.00, 95% CI:1.05, 3.84), previous experience of similar illnesses (AOR = 3.67, 95% CI:1.36, 9.86) and previous history of under-five child death (AOR = 13.31, 95% CI:5.13, 34.53).

Conclusions

The common under-five childhood illnesses were acute respiratory tract infection and diarrhea. The study also revealed that there was a delay in seeking healthcare and this was significantly associated with age of the child; mothers/caregivers level of education; family size; perception of illness severity; previous experience of similar illnesses and under-five child death.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1588-2) contains supplementary material, which is available to authorized users.

Epidemiological investigation and management of bloody diarrhea among children in India

BACKGROUND

The evidence on the factors associated with childhood bloody diarrhea in developing countries in general and India, in particular, is somewhat limited. Our study, therefore, examines-the prevalence of bloody diarrhea; the magnitude of treatment of bloody diarrhea (use of both oral rehydration and antibiotics (pills, syrups, and injections)); and several other associated factors with bloody diarrhea in the youngest children under five years in the Indian context.

METHODS

We used data from the National Family Health Survey (NFHS)-4 conducted in 2015-16. We used a multivariable binary logistic regression model to identify the factors associated with bloody diarrhea. We also applied a multinomial logistic regression model to identify associated factors with the treatment of bloody diarrhea amongst the youngest children below five years.

FINDINGS

The overall prevalence of bloody diarrhea in the youngest children was about 9 percent in the last two weeks preceding the survey. There was a significant difference in the mean age of those children having bloody diarrhea and watery diarrhea during the same period. Children whose stools were disposed of unsafely and those who belonged to households with neither a place nor water for washing hands were more likely to suffer from bloody diarrhea compared to their counterparts with these facilities. About a little less than one-fifth of the youngest children (16%) received adequate treatment of bloody diarrhea. The treatment of bloody diarrhea was associated with the health facility and maternal and children's socioeconomic and demographic characteristics.

CONCLUSION

The study shows that household environmental risk factors are important predictors of bloody diarrhea amongst the youngest children. Still, 28% of those children did not receive any treatment of bloody diarrhea in India. There is also a clear need to promote the practice of safe disposal of children's stools and handwashing among mothers and children. Mothers need to be sensitized about the necessity of an immediate visit to a health facility/center in case of bloody diarrhea.

Determinants of delay in timely treatment seeking for diarrheal diseases among mothers with under-five children in central Ethiopia: A case control study

Background

Delays in seeking timely appropriate care contributes to a large number of deaths from diarrhea in children. This study aimed to identify determinants of delays in seeking timely treatment by mothers/caregivers of under-five children with diarrheal diseases.

Methods

We used an unmatched case-control study from February—March 2017 among 316 children: 158 cases and 158 controls. Cases were mothers/caregivers with under-five children who had signs/symptoms of diarrhea and sought treatment after 24 hours onset of symptom. Controls sought treatment within 24 hours. Field workers collected data using a pre-tested standardized questionnaire. Multivariate logistic regression was conducted to identify determinants of delay in timely diarrhea treatment seeking. Statistical significance was declared by using a p-value<0.05 and 95% of confidence interval (CI) for an adjusted-odds ratio (AOR).

Results

The determinants of delay in timely treatment seeking of mothers/caregivers of under-five children with diarrheal diseases were children <24months (AOR = 1.9,95%CI:1.1–3.4); fail to attend school (AOR = 2.4, 95%CI:1.2–4.6); being female children (AOR = 1.7,95%CI:1.05–2.9); preferring government health facility for the treatment of children with diarrheal diseases (AOR = 2.9, 95%CI, 1.3–6.7); lack of past history taking children to health facility and lack of counseling (AOR = 4.8, 95%CI:2.0–12.1); being in the15-25 years age (AOR = 1.7, 95%CI:1.1–3.0) and taking children to a health facility as a first response to diarrhea (AOR = 0.1, 95%CI:0.01–0.8).

Conclusions

Age of the child, maternal age, and disease related determinants were determinants for seeking timely treatment to diarrheal diseases. Providing skilled based health education and counseling to mothers/caregivers on seeking timely treatment and taking children with diarrheal diseases to a health facility as a first response to diarrhea is a paramount intervention to reduce morbidity and mortality of children.

What are the differences among occupational groups related to their palliative care-specific educational needs and intensity of interprofessional collaboration in long-term care homes?

Background

The purpose of this study was to compare the differences across occupational groups related to their end-of-life care-specific educational needs and reported intensity of interprofessional collaboration in long-term care (LTC) homes.

Methods

A cross-sectional survey, based on two questionnaires, was administered at four LTC homes in Ontario, Canada using a modified Dilman’s approach. The first questionnaire, End of Life Professional Caregiver Survey, included three domains: patients and family-centered communication, cultural and ethical values, effective care delivery. The Intensity of Interprofessional Collaboration Scale included two subscales: care sharing activities, and interprofessional coordination. In total, 697 LTC staff were given surveys, including personal support workers, support staff (housekeeping, kitchen, recreation, laundry, dietician aids, office staff), and registered staff (licensed nurses, physiotherapists, social workers, pharmacists, physicians).

Results

A total of 317 participants completed the survey (126 personal support workers, 109 support staff, 82 registered staff) for a response rate of 45%. Significant differences emerged among occupational groups across all scales and subscales. Specifically, support staff rated their comfort of working with dying patients significantly lower than both nurses and PSWs. Support staff also reported significantly lower ratings of care sharing activities and interprofessional coordination compared to both registered staff and personal support workers.

Conclusions

These study findings suggest there are differing educational needs and sense of interprofessional collaboration among LTC staff, specific to discipline group. Both the personal support workers and support staff groups appeared to have higher needs for education; support staff also reported higher needs related to integration on the interdisciplinary team. Efforts to build capacity within support staff related to working with dying residents and their families are needed. Optimal palliative care may require resources to increase the availability of support for all staff involved in the care of patients.

Contextual factors associated with health care service utilization for children with acute childhood illnesses in Nigeria

OBJECTIVE

To examine the independent contribution of individual, community and state-level factors to health care service utilization for children with acute childhood illnesses in Nigeria.

MATERIALS AND METHODS

The study was based on secondary analyses of cross-sectional population-based data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel logistic regression models were applied to the data on 6,427 under-five children who used or did not use health care service when they were sick (level 1), nested within 896 communities (level 2) from 37 states (level 3).

RESULTS

About one-quarter of the mothers were between 15 and 24 years old and almost half of them did not have formal education (47%). While only 30% of the children utilized health service when they were sick, close to 67% lived in the rural area. In the fully adjusted model, mothers with higher education attainment (Adjusted odds ratio [aOR] = 1.63; 95% credible interval [CrI] = 1.31-2.03), from rich households (aOR = 1.76; 95% CrI = 1.35-2.25), with access to media (radio, television or magazine) (aOR = 1.18; 95% CrI = 1.08-1.29), and engaging in employment (aOR = 1.18; 95% CrI = 1.02-1.37) were significantly more likely to have used healthcare services for acute childhood illnesses. On the other hand, women who experienced difficulty getting to health facilities (aOR = 0.87; 95% CrI = 0.75-0.99) were less likely to have used health service for their children.

CONCLUSIONS

Our findings highlight that utilization of healthcare service for acute childhood illnesses was influenced by not only maternal factors but also community-level factors, suggesting that public health strategies should recognise this complex web of individual composition and contextual composition factors to guide provision of healthcare services. Such interventions could include: increase in female school enrolment, provision of interest-free loans for small and medium scale enterprises, introduction of mobile clinics and establishment of more primary health care centres.

Demographic and mortality analysis of hospitalized children at a referral hospital in Addis Ababa, Ethiopia

BACKGROUND

Global childhood mortality rates remain high. Millennium Development Goal 4 focused efforts on reducing rates by two-thirds between 1990 and 2015. In Ethiopia, child mortality rates dropped 71 % from 1990 to 2015, however it is estimated that 184,000 Ethiopian children die each year. There is limited information about pediatric hospital admissions in Ethiopia. Our aims were to examine the temporal relationship of mortality to admission, describe the demographics, and identify cause mortality of children admitted to the Zewditu Memorial Hospital (ZMH).

METHODS

A four-year retrospective review of pediatric admissions was conducted at the pediatric emergency room and pediatric hospital ward at ZMH in Addis Ababa, Ethiopia. Admission entries from 2011-2014 of children age 29 days-14 years were reviewed. Age, gender, admission date, disease classification, discharge status and date were obtained. Patient gender was compared using Chi-square analysis. A descriptive analysis was used for age and cause mortality.

RESULTS

A total of 6866 patient entries were reviewed. The proportion of admissions younger than age 5 was 0.747 (95 % CI 0.736-0.757). Overall mortality was 0.042 (95 % CI, 0.037-0.047). The proportion of recorded deaths occurring within 2 days of admission was 0.437 (95 % CI 0.380-0.494). The proportion of male admissions was significantly higher than female admissions in all age groups (male 0.575, p < 0.0001, 95 % CI 0.562-0.586). The main causes of mortality were pneumonia (0.253, 95 % CI, 0.203-0.303), severe acute malnutrition (0.222, 95 % CI 0.174-0.27), HIV/AIDS-related complications (0.056, 95 % CI 0.029-0.083), spina bifida (0.049, 95 % CI 0.024-0.074), and hydrocephalus (0.045, 95 % CI 0.021-0.069).

CONCLUSIONS

Our study revealed a lower mortality rate than previously reported in Ethiopia. Despite this, 44 % of pediatric hospital mortality occurred early during hospitalization, higher than reported at other Ethiopian hospitals. This adds further evidence that systematic efforts should be dedicated to improve pediatric emergency care. Admissions included 58 % male patients, similar to other reports in Ethiopia implying that this may be a nation-wide phenomenon. The observed disparity may be due to societal factors regarding care-seeking behaviors or male predilection for respiratory illness warranting further investigation. Cause mortality patterns were similar to reports in analogous settings.