Socio-economic determinants in selecting childhood diarrhoea treatment options in Sub-Saharan Africa: a multilevel model

A scoping review on efficacy and safety of medicinal plants used for the treatment of diarrhea in sub-Saharan Africa

BACKGROUND

In sub-Saharan Africa (SSA), significant morbidity and mortality have been linked to diarrhea, which is frequently caused by microorganisms. A rise in antimicrobial-resistant pathogens has reignited the search for alternative therapies. This scoping review aims to map the literature on medicinal plants in relation to their anti-diarrheal potential from SSA.

METHODS

Studies published from 1990 until April 2022 on medicinal plants used for the treatment of diarrhea from each country in SSA were searched on Scopus, Web of Science, Science Direct and PubMed. The selection of articles was based on the availability of data on the in vitro and/or in vivo, ethnobotanical, and cross-sectional studies on the efficacy of medicinal plants against diarrhea. A total of 67 articles (ethnobotanical (n = 40); in vitro (n = 11), in vivo (n = 7), cross-sectional (n = 3), in vitro and in vivo (n = 2) and ethnobotanical and in vitro (n = 2), were considered for the descriptive analysis, which addressed study characteristics, herbal intervention information, phytochemistry, outcome measures, and toxicity findings.

RESULTS

A total of 587 different plant species (from 123 families) used for diarrhea treatment were identified. Most studies were conducted on plants from the Fabaceae family. The plants with the strongest antimicrobial activity were Indigofera daleoides and Punica granatum. Chromatographic methods were used to isolate six pure compounds from ethyl acetate extract of Hydnora johannis, and spectroscopic methods were used to determine their structures. The majority of anti-diarrheal plants were from South Africa (23.9%), Ethiopia (16.4%), and Uganda (9%). This study highlights the value of traditional remedies in treating common human diseases such as diarrhea in SSA.

CONCLUSION

Baseline knowledge gaps were identified in various parts of SSA. It is therefore recommended that future ethnobotanical studies document the knowledge held by other countries in SSA that have so far received less attention. Additionally, we recommend that future studies conduct phytochemical investigations, particularly on the widely used medicinal plants for the treatment of diarrheal illnesses, which can serve as a foundation for future research into the development of contemporary drugs.

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.

The association between contraceptive use and desired number of children among sexually active men in Zambia

BACKGROUND

Contraceptive methods have been used to space births, but also to limit a couple's desired number of children. Efforts of family planning programmes have mainly concentrated on females, even though males tend to have large say on the desired number of children a couple should have. In our study, we sought to determine linkages between contraceptive use and desired number of children, as well as associated demographic and socio-economic characteristics, among sexually active males in Zambia.

METHODS

The main outcome variable of interest was desired number of children as measured by ideal number of children which is a count variable. Data for this paper was the male dataset from the 2018 Zambia Demographic and Health Survey, a cross-sectional national survey. Binary logistic regression was performed to determine odds ratios of contraceptive use by selected characteristics of sexually active males. Multivariate Poisson Regression Model was used to establish factors associated with desired number of children.

RESULTS

Age of men (20-29, 30-39 and 40-49 years), residence in rural areas, wealth quintile, Protestant or Muslim religious affiliation, media exposure, and having discussed family planning with a health worker in the last few months prior to the survey were associated with contraceptive use. Sexually active males who reported using any contraception method reported 3% less desired number of children compared to those who were not using any method. Older males (age group 30-49 years), resident in rural areas, with primary education, married, employed, Protestant religion, and those labelling women who use contraceptives "as promiscuous" had more desired number of children.

CONCLUSIONS

There were minimal differences in the desired number of children among males who reported using and not using any contraceptive method. Strategies aimed at encouraging contraception use should cover all categories of males to achieve universal involvement of men in family planning in Zambia. Future research may consider combining both qualitative and quantitative methods to look holistically at the demographic, socio-economic and cultural factors associated with non-contraception use and desired number of children among sexually active men in Zambia.

Health-care seeking for childhood diseases by parental age in Western and Central Africa between 1995 and 2017: A descriptive analysis using DHS and MICS from 23 low- and middle-income countries

BACKGROUND

Globally, health care seeking for childhood diseases seems to be on the rise. However, progress is slow and still, many cases of infectious diseases in children remain untreated, leading to preventable child mortality. A better understanding of care seeking behaviour may help to further increase the probability that a sick child is taken to a health facility for care.

METHODS

We investigated whether mother's and father's age at birth of the child is associated with health care seeking behaviour for childhood diseases and how this association changed over time. For this observational study, we used repeated cross-sectional data, namely all available Demographic and Health Surveys as well as Multi-Indicator Cluster Surveys from Western and Central Africa, 1995 to 2017. We analysed care seeking behaviour for diarrhoea, acute respiratory infections (ARI), and treatment of diarrhoea with oral rehydration solution (ORS). We estimated ordinary least squares regressions, controlling for socioeconomic characteristics of the household and adding survey year- and country-fixed effects. Estimated associations are presented for the entire region and for each country separately to highlight heterogeneity.

RESULTS

Overall, the likelihood that care is sought for a child suffering from diarrhoea or ARI is low in Western and Central Africa. Probability of care seeking for diarrhoea ranges between 49% for mothers above 40 years and 53% for mothers between 25 and 29 years. For ARI, the rates are 60% and 62%, respectively. Treatment of diarrhoea with ORS is even lower, ranging between 23% and 26%. The probability that parents seek health care for their child does not seem to be associated with parents' age at birth. Mother's level of education and household's wealth status seem to be more important factors. There is evidence of the relationship between parents' age and care seeking changing over time, suggesting a stronger association in the past.

CONCLUSIONS

Parents' age at child birth does not seem to have a relevant association with care seeking for common childhood diseases. Identifying relevant factors may help in improving health care seeking behaviour of parents in low- and middle-income countries leading to reductions in child morbidity and mortality.

Protective effects of Crataegus azarolus L. berries aqueous extract against castor oil-induced diarrhea, oxidative stress, and inflammation in rat

BACKGROUND

Diarrhea is a multifactorial gastrointestinal disorder responsible for about 5 million deaths annually. The chemical composition, the antioxidant activity of Crataegus azarolus berries aqueous extract (CABAE) as well as its protective effects against castor oil-induced diarrhea, oxidative stress, and inflammation in rat were studied.

METHODS

Sixty male rats were used and divided into six groups of ten animals in each: Control (C), castor oil (CO), CO+various doses of CABAE (100, 200, and 400 mg/kg b.w., p.o.), and CO+loperamide (LOP, 10 mg/kg b.w., p.o.).

KEY RESULTS

The CABAE showed relatively high levels of total polyphenols, flavonoids, and tannins. The LC-HRESIMS technique allowed the identification of 5 phenolic compounds and the major component is quinic acid. In vivo studies showed that CABAE protected against castor oil-induced diarrhea and intestinal fluid accumulation. The CABAE counteracted castor oil-induced lipoperoxidation, preserved GSH and thiol groups levels, and prevented the depletion of antioxidant enzyme activities, such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). The CABAE administration also protected against castor oil-induced inflammatory markers (ALP and CRP) increase. More importantly, castor oil induced an increase of intracellular mediators, such as hydrogen peroxide, free iron, and calcium, while CABAE pretreatment significantly reversed them to near control levels.

CONCLUSION

The Crataegus azarolus berries aqueous extract significantly protected against diarrhea due in part to its antioxidant and anti-inflammatory properties.

Prevalence and socio-demographic determinants of diarrhea among children below 5 years in Bondhere district Somalia

Introduction

globally diarrhea is rated as the second leading cause of mortality among children below the age of five years. The highest rates of morbidity and mortality as a result of diarrhea are reported in sub-Saharan Africa and South East Asia. Studies have documented Somalia as among the countries with significant high rates of diarrhea among children below the age of 5 years. The aim of the study was to assess the prevalence and socio-demographic determinants of diarrhea.

Methods

the study employed a descriptive cross-sectional study design where data was collected using semi structured questionnaires. Simple random sampling was employed to identify caregivers that were included in the study. The data collected was analyzed using SPSS version 20 at 95% confidence interval. Both descriptive and regression analysis were carried out. The data was presented using tables and graphs. Ethical clearance was sought from University of Eastern Africa Baraton ethical review committee. Permission and consent were sought from the administrative leadership of Bondhere district and caregivers respectively.

Results

the prevalence of diarrhea among children under 5 years was 22.4%. Socio-demographic factors reported to significantly influence the prevalence of diarrhea among children under years were caregiver education level and number of children under 5 years.

Conclusion

the prevalence of diarrhea among children under 5 years was considerably high. Several socio-demographic factors were associated with diarrhea. The study recommends improvement of education and sensitization of communities on family planning.

Child Caregiver's healthcare seeking behavior and its determinants for common childhood illnesses in Addis Ababa, Ethiopia: a community-based study

BACKGROUND

Appropriate healthcare-seeking behavior and access to the health care facility is key to improving health service utilization. Although the accessibility of comprehensive childhood disease intervention services in Ethiopia has been modified at the community level, the use of such health care services has remained limited. Therefore, this study aimed to assess the healthcare-seeking behavior of common childhood illness and its determinants.

METHODS

A community-based cross-sectional study design was used. A multi-stage sampling method was used to recruit eight hundred and thirty-four study participants. A pre-tested and standardized questionnaire was used to collect data. The collected data were visually checked for incompleteness and entered into the statistical software Epi-info version 7 and exported to SPSS version 20 software for descriptive and bi-variable analysis. To identify variables associated with the healthcare-seeking behavior. Logistic regression analysis was performed. Adjusted odds ratios with a 95% confidence interval were used to see the strength of association, and variables with P-values of < 0.05 were considered statistically significant.

RESULTS

The proportion of health care seeking behavior of care-givers for childhood illness was 69.5% (95% CI, 66.4, 72.4%). The education level of caregiver (AOR: 1.61, 95% CI: 1.01-2.60), knowledge of childhood illness (AOR: 2.02, 95% CI: 1.46-2.79), cough (AOR: 1.94, 95% CI: 1.39-2.71) and diarrhea (AOR: 2.09, 95% CI: 1.46-2.99) as main symptoms of illness and perceived severity of illness (AOR:3.12, 95% CI: 2.22-4.40) were significantly associated with healthcare-seeking behaviors of caregivers.

CONCLUSION

Low healthcare-seeking behavior was observed for childhood illnesses. Educational level, knowledge of childhood illness, cough, and diarrhea as primary symptoms of illness, and perceived severity of caregiver illness were significant associated with healthcare-seeking behavior. Therefore, interventions that strengthen the caregiver's awareness of childhood illness and danger signs need to be considered. Besides, addressing the identified associated variables to healthcare-seeking behavior is critically important to curb the problem.

Women's autonomy in healthcare decision-making and healthcare seeking behaviour for childhood illness in Ghana: Analysis of data from the 2014 Ghana Demographic and Health Survey

INTRODUCTION

The capacity of women to decide on their healthcare plays a key role in their health. In this study, we examined the association between women's healthcare decision-making capacity and their healthcare seeking behaviour for childhood illnesses in Ghana.

MATERIALS AND METHODS

We used data from the 2014 Ghana Demographic and Health Survey. A total sample of 2,900 women with children less than 5 years was used for the analysis. Data were processed and analysed using STATA version 14.0. Chi-square test of independence and binary logistic regression were carried out to generate the results. Statistical significance was pegged at 95% confidence intervals (CIs). We relied on the 'Strengthening the Reporting of Observational Studies in Epidemiology' (STROBE) statement in writing the manuscript.

RESULTS

Out of the 2,900 women, approximately 25.7% could take healthcare decisions alone and 89.7% sought healthcare for childhood illnesses. Women who decided alone on personal healthcare had 30% reduced odds of seeking healthcare for childhood illnesses compared to those who did not decide alone [AOR = 0.70, CI = 0.51-0.97]. With age, women aged 45-49 had 69% reduced odds of seeking healthcare for childhood illnesses compared to those aged 25-29 [AOR = 0.31, CI = 0.14-0.70]. Women from the Northern and Upper West regions had 72% [AOR: 0.28, CI: 0.11-0.70] and 77% [AOR: 0.23, CI: 0.09-0.58] reduced odds of seeking healthcare for childhood illnesses respectively, compared to those from the Western region.

CONCLUSION

Ghanaian women with autonomy in healthcare decision-making, those who were older and those from the Northern and Upper West regions were less likely to seek healthcare for childhood illness. To reduce childhood mortalities and morbidities in Ghana, we recommend educating women such as those who take healthcare decisions alone, older women and women from deprived regions like the Northern and Upper West regions on the need to seek healthcare for childhood illnesses.

Factors associated with healthcare seeking behaviour for children in Malawi: 2016

OBJECTIVE

To characterise health seeking behaviour (HSB) and determine its predictors amongst children in Malawi in 2016.

METHODS

We used the 2016 Malawi Integrated Household Survey data set. The outcome of interest was HSB, defined as seeking care at a health facility amongst people who reported one or more of a list of possible symptoms given on the questionnaire in the past two weeks. We fitted a multivariate logistic regression model of HSB using a forward step-wise selection method, with age, sex and symptoms entered as a priori variables.

RESULTS

Of 5350 children, 1666 (32%) had symptoms in the past two weeks. Of the 1666, 1008 (61%) sought care at health facility. The children aged 5-14 years were less likely to be taken to health facilities for health care than those aged 0-4 years. Having fever vs. not having fever and having a skin problem vs. not having skin problem were associated with increased likelihood of HSB. Having a headache vs. not having a headache was associated with lower likelihood of accessing care at health facilities (AOR = 0.50, 95% CI: 0.26-0.96, P = 0.04). Children from urban areas were more likely to be taken to health facilities for health care (AOR = 1.81, 95% CI: 1.17-2.85, P = 0.008), as were children from households with a high wealth status (AOR = 1.86, 95% CI: 1.25-2.78, P = 0.02).

CONCLUSION

There is a need to understand and address individual, socio-economic and geographical barriers to health seeking to increase access and use of health care and fast-track progress towards Universal Health Coverage.

Predictors of diarrhea episodes and treatment-seeking behavior in under-five children: a longitudinal study from rural communities in Zambia

Introduction

globally, diarrhea is the second leading cause of mortality in children aged below five years, and is responsible for killing about 760 000 children every year. Poor treatment-seeking behavior among caretakers remains a major challenge in low-income countries. The current study aimed to determine the predictors of diarrhea episodes and treatment-seeking behavior among under-five children of Chivuna and Magoye in Zambia.

Methods

we conducted a community-based longitudinal study among 1216 children aged 12-59 months between July 2006 and June 2007. A structured interviewer-administered questionnaire was used to collect data on demographic factors, diarrhea episodes and treatment-seeking behavior from caretakers. Chi-square, one-sample test of proportions and logistic regression were the statistical methods used in this study.

Results

of the 1216 children who participated in the study, 698 (57%) were from Chivuna and 518 (43%) from Magoye. Factors associated with diarrhea episodes were location (children in Chivuna had increased episodes of diarrhea; aOR 1.32; 95%CI 1.15, 1.52) and age distribution (children aged 37-59 months vs. 12-36 months had reduced episodes of diarrheal aOR 0.81; 95%CI 0.72, 0.91). Fifty two percent (52%) of the diarrhea cases had their treatment sought within 24 hours of onset (early treatment). Thirty one percent (31%) of the diarrhea cases had their early treatment at a health facility. Female children (52%) had the majority of their diarrhea episodes treated within 24 hours of onset. The higher proportion of diarrhea episodes had their treatment at home (52%). Children who did not have home treatment had a significantly reduced chance of having early treatment (aOR 0.62; 95%CI 0.47, 0.82).

Conclusion

this study revealed that diarrhea episodes and treatment seeking behavior in under-5 children is of public health concern. There is need to re-enforce the preventative and control measures aimed at reducing diarrhea in under-5 children, and interventions should take into account the different predictors of diarrhea and treatment seeking behavior in different settings, like the ones highlighted in this study.

Association between Maternal High-Risk Fertility Behavior and Childhood Morbidity in Bangladesh: A Nationally Representative Cross-Sectional Survey

In this cross-sectional study, we evaluated data from the 2014 Bangladesh Demographic and Health Survey (BDHS), which consisted of 7,707 married women aged 15-49 years who lived with at least one child younger than 5 years. This study's primary aim was to examine the relationship between maternal high-risk fertility behavior and child morbidity. To define high-risk fertility behaviors, we considered three variables: maternal age at the time of delivery, birth order, and birth interval. The main outcome measures were mortality-related disease in the past 2 weeks (acute respiratory infection [ARI], diarrhea, and fever) and low birth weight (LBW). We used modified Poisson regression with generalized estimating equations to assess the relationships between the variables of interest. Results indicate that a substantial portion of women (34%) exhibited high-risk fertility patterns; 28.7% engaged in a single high-risk behavior and 5.4% engaged in multiple high-risk behaviors. After adjusting for relevant covariates, high-risk fertility behaviors were significantly associated with an increased likelihood of ARI (adjusted relative risk [ARR]: 1.22, 95% CI: 1.05-1.50), diarrhea (ARR: 1.18, 95% CI: 1.03-1.35), fever (ARR: 1.29, 95% CI: 1.11-1.58), and LBW (ARR: 1.27, 95% CI: 1.10-1.52). In addition, engaging in multiple high-risk fertility behaviors appeared to have far-reaching consequences on the outcomes measured. Maternal high-risk fertility behaviors are important predictors of morbidity in children younger than 5 years. Preventing high-risk fertility behavior may reduce childhood morbidity and mortality in Bangladesh.

Associations between parental socioeconomic position and health-seeking behaviour for diarrhoea and acute respiratory infection among under-5 children in Myanmar: a cross-sectional study

OBJECTIVES

To examine the associations of parental social and economic position with health-seeking behaviour for diarrhoea and acute respiratory infection (ARI) among under-5 children in Myanmar and explore potential underlying mechanisms.

DESIGN

A cross-sectional study.

SETTING

A secondary dataset from the nationwide 2015-2016 Myanmar Demographic and Health Survey (MDHS).

PARTICIPANTS

All under-5 children in the sampled households with reported symptoms of diarrhoea and ARI during the 2-week period preceding the MDHS survey interview.

PRIMARY AND SECONDARY OUTCOME MEASURES

Four parental health-seeking behaviours: 'seeking treatment', 'formal health provider', 'public provider' and 'private provider' were considered. Social and economic positions were determined by confirmatory factor analysis. Multilevel logistic regressions were employed to examine the associations of social and economic positions with health-seeking behaviours for diarrhoea and ARI. Mediation analyses were conducted to explore potential underlying mechanisms in these associations.

RESULTS

Of the 4099 under-5 children from the sampled households in MDHS, 427 (10.4%) with diarrhoea and 131 (3.2%) with ARI were considered for the analyses. For diarrhoea, social position was positively associated with seeking treatment and private provider use (adjusted OR: 1.60 (95% CIs: 1.07 to 2.38) and 1.83 (1.00 to 3.34), respectively). Economic position was positively associated with private provider use for diarrhoea (1.57 (1.07 to 2.30)). Negative associations were observed between social and economic positions with public provider use for diarrhoea (0.55 (0.30 to 0.99) and 0.64 (0.43 to 0.94), respectively). Social position had more influence than economic position on parental health-seeking behaviour for children with diarrhoea. No evidence for a significant association of social and economic position with health-seeking for ARI was observed.

CONCLUSIONS

Social and economic positions were possible determinants of health-seeking behaviour for diarrhoea among children; and social position had more influence than economic position. The results of this study may contribute to improve relevant interventions for diarrhoea and ARI among children in Myanmar.

Etiologies of diarrhea and drug susceptibility patterns of bacterial isolates among under-five year children in refugee camps in Gambella Region, Ethiopia: a case control study

Background

Despite substantial global effort and updated clinical management guidelines, diarrhea continues to be among leading worldwide causes of morbidity and mortality in children. Infectious diarrhea, the most common form of diarrhea causes substantial morbidity and mortality among children in developing countries, and the muddled use of antibiotics needs caution due to potential problems of drug-resistance. The aim of this study is to identify etiologies of diarrhea and drug susceptibility patterns of bacterial isolates in under-five children in refugee camps in Gambella Region, Ethiopia.

Methods

An institution- based matched case control study was conducted using a questionnaire-based interview from June to December 2017 in Pugnido and Teirkidi refugee camps. Stool samples were collected and parasites causing diarrhea were identified by wet mount microscopy. Conventional culture supplemented with API 20E identification kit was used to identify Salmonella and Shigella species. Antibiotic susceptibility of bacterial isolates was investigated by using the disk diffusion method. The association between etiologies and diarrhea was analyzed using McNemar test or Fisher exact test with 95% confidence interval at a level of significance of P < 0.05.

Results

The overall prevalence of enteric pathogens were 55 (41.0%) in diarrhea cases and 18 (13.4%) in healthy controls. The detected etiologies include Giardia lambia (28), Shigella spp. (16), E. hystolyotica/dispar (13), Ascaris lumbricoides (10), Salmonella spp. (6), Cryptosporidium parvum (6), Hymenolepis nana (4) and Isospora belli (3). All isolates were sensitive to kanamycine and ceftazidime. The high resistance rate was observed against ampicillin (100%), amoxicillin (100%), erythromycin (52%), chloramphenicol (47.5%), tetracycline (40.5%), cotrimoxazole (34.8%) and amoxicillin-clavulanic acid (33%). The majorities of the isolates had a low rate of resistance to ciprofloxacin (8.7%), naldxic acid (8.7%) and amikacin (13%).

Conclusions

Giardia lamblia, E. Hystolytica/dispar, and Shigella spp are the common etiologies of diarrhea in children in the studied refugee camps. The study also showed that significant numbers of bacterial isolates were resistant to the commonly used antimicrobial drugs. Therefore, improving clinical laboratory services and promoting evidence-based drug prescription may reinforce proper use of antibiotics and reduce the emergence of microbial resistance.

Assessment of Poor Home Management Practice of Diarrhea and Associated Factors among Caregivers of Under-Five Years Children in Urban and Rural Residents of Doba Woreda, Ethiopia: Comparative Cross-Sectional Study

Background

Diarrhea is the first cause of illness and the second cause of death in under-five children. Home interventions can prevent 57% of mortality related to diarrhea. However, malpractices were common and the reason for this underutilization was unclear. Thus, this study was aimed at assessing poor home management practice of Diarrhea and associated factors among caregivers of under-five years children in urban and rural residents.

Methods

The community-based comparative cross-sectional study was conducted in Doba woreda, Ethiopia, from February 25 to March 15, 2017. Multistage cluster sampling technique was used to study 559 caregivers. An interviewer administered pretested structured questionnaire was used to collect data. Collected data were entered into Epi Info version 3.5.1 and exported to statistical package for social sciences (SPSS) version 20.0 for analysis. The binary logistic regression model was used. In bivariate analysis p-value<0.25 was taken into multivariable analysis. Adjusted odds ratios with their corresponding 95% of CI were used to report results with a significance level of p-value<0.05.

Result

184 urban and 375 rural caregivers were included in the study. Poor home management practice was 55.8% of urban and 85.6% of rural residents. Knowledge level (AOR=2.7(CI[1.3, 6.5]) and AOR=13.4(CI[5.3, 34.0]) and difficulty in preparing oral rehydration salt (AOR=4.0CI[1.4, 11.0]) and AOR=2.4(1.3, 5.3)) were associated factors for both urban and rural residents, respectively. Caregivers of male index child (AOR=2.3(1.2, 4.7)) and age of the caregivers (AOR=0.26(0.09, 0.8)) were associated with poor home practice for urban residents. In rural residents, inaccessibility to zinc supplementation (AOR=2.4(1.2, 5.0)) was among associated factors.

Conclusion

Poor home management practice of diarrhea was high in both urban and rural residents. It was higher in rural compared to urban residents. Poor practice was associated with knowledge level, age of the caregivers, sex of the index child, and accessibility of zinc. Health education and community mobilization on home management of diarrhea are important to increase awareness and improve practice level.

Household relationships and healthcare seeking behaviour for common childhood illnesses in sub-Saharan Africa: a cross-national mixed effects analysis

Background

Intra-household dynamics play crucial roles in utilisation of healthcare services for children. We investigated the influence of household relationships on healthcare seeking behaviour for common childhood illnesses in four sub-Sahara African regions.

Methods

Data on 247,061 under-five children were extracted from recent Demographic and Health Surveys conducted between 2012 and 2016 in 25 countries. Data were combined and analysed per sub-region. Dependent variables (DVs) were uptake of health facility care for diarrhea and Acute Respiratory Tract Infection (ARI) symptoms. The main independent variable (IV) was household relationship which was represented by maternal marital profile (marital status, family type and number of marriages) and maternal relationship to household head. Mixed effects logit models were fitted to assess independent relationship between the IVs and DVs with adjustment for relevant demographic and socio-economic characteristics at 5% significance level.

Results

The percentage of children who received care for diarrhea and ARI symptoms from health facilities across sub-regions was: Western Africa (WA) 42.4, 44.1%; Central Africa (CA) 32.6, 33.9%; Eastern Africa (EA) 41.5, 48.7% and Southern Africa (SA) 58.9, 62.7%. Maternal marital profile was not associated with healthcare seeking behaviour for diarrhea and ARI symptoms in any of the sub-regions. Children whose mothers were daughter/daughter-in-law to household head were significantly less likely to be taken to health facility for diarrhea treatment in Eastern Africa (AOR = 0.81, CI: 0.51–0.95). Having a mother who is the head of household was significantly associated with higher odds of facility care for ARI symptoms for children from Western (AOR = 1.20, CI: 1.02–1.43) and Southern Africa (AOR = 1.49, CI: 1.20–1.85).

Conclusion

The type of relationship between mother of under-fives and head of households affect health seeking behaviour for treatment of diarrhea and ARI symptoms in Eastern, Western and Southern Africa. Countries in these regions need to adapt best practices for promoting healthcare utilisation for children such that household relationship does not constitute barriers.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4142-x) contains supplementary material, which is available to authorized users.

Health care utilization for common childhood illnesses in rural parts of Ethiopia: evidence from the 2016 Ethiopian demographic and health survey

Background

Generally, health care utilization in developing countries is low particularly rural community have lower health care utilization. Despite this fact, little is known about the magnitude and determinants of health care utilization for common childhood illnesses in Ethiopia. Thus, this study was conducted to determine the magnitude and to identify determinants of health care utilization for common childhood illnesses in the rural parts of Ethiopia.

Methods

For this study, data were obtained from the 2016 Ethiopian demographic and health survey. A total of 1576 mothers of under-five children were included in the analysis. Data analysis was performed using R software. Both univariable and multivariable logistic regression analysis were fitted to identify the determinants of health care utilization. Variables with a 95% confidence interval for odds ratio excluding one were considered as significant determinants of the outcome.

Results

The findings of this study revealed that only half (49.7%) (95%CI: 46.1–53.4%), 40.9% (95%CI 37.6–44.2%), and 38.0% (95%CI: 34.7–41.4%) of the children utilized health care for diarrhea, fever, and cough, respectively. Children age between 12 and 23 months (AOR: 1.58, 95%CI: 1.08–2.31), maternal education (AOR: 1.96, 95%CI: 1.34–2.88), and giving birth at health facilities (AOR: 1.49, 95%CI: 1.04–2.13) were found to be the determinants of health care utilization for diarrhea. Marital status (AOR: 0.25, 95%CI: 0.06–0.81), husbands’ education (AOR: 1.37, 95%CI: 1.01–1.86), and giving birth at health facilities (AOR: 1.51, 95%CI: 1.09–2.10) were factors significantly associated with health care utilization for fever. Children age between 12 and 23 months (AOR: 1.51, 95%CI: 1.03–2.22), maternal education (AOR: 1.70, 95%CI: 1.18–2.44), and giving birth at health facilities (AOR: 1.74, 95%CI: 1.23–2.46) were significantly associated with health care utilization for cough.

Conclusions

Low health care utilization for childhood illnesses was noticed. The health care utilization for diarrhea and cough was lower for children of ages between 0 and 11 months, mothers without formal education and home-delivered children’s. The health care utilization for fever was lower for separated parents, husbands without formal education, giving birth at home and from the poorest family. Programs to improve the educational status of a household are essential for better care utilization and children development.

Trends for Diarrhea Morbidity in the Jasikan District of Ghana: Estimates from District Level Diarrhea Surveillance Data, 2012-2016

About 22% of childhood deaths in developing countries are attributable to diarrhea. In poor resource settings, diarrhea morbidities are correlated with poverty and socio-contextual factors. Diarrhea rates in Ghana are reported to be high, with cases estimated at 113,786 among children under-five years in 2011. This study analyzed the trends of diarrhea morbidity outcomes in the Jasikan District of Ghana. A retrospective analysis of records on diarrhea data for a five years' period (January 2012 to December 2016) was undertaken. There was a total of 17740 diarrhea case reports extracted from District Health Information Management System (DHIMS) II database in an Excel format which was then exported to Stata version 14 for data cleaning, verification, and analysis. Excel version 2016 was used to plot the actual observed cases by years to assess trends and seasonality. There was a period incidence rate of 272.02 per 1000 persons with a decreasing annual growth rate of 1.85%. Declines for diarrhea generally occurred from November to December and increased from January upwards, evidence that most cases of diarrhea in this study were reported in the harmattan season. High incidence of diarrhea was found to be common among under-five children and among females. Decreasing trend of diarrhea incidence which was identified in this research within the five years' period understudied shows that, by the year 2020, there will be a sharp decline in the incidence rate of diarrhea reported cases in Jasikan District, given improvements in the external environmental conditions in the district, all things being equal.

Beyond causes of death: The social determinants of mortality among children aged 1-59 months in Nigeria from 2009 to 2013

Background

Millions of children worldwide suffer and die from conditions for which effective interventions exist. While there is ample evidence regarding these diseases, there is a dearth of information on the social factors associated with child mortality.

Methods

The 2014 Verbal and Social Autopsy Study was conducted based on a nationally representative sample of 3,254 deaths that occurred in children under the age of five and were reported on the birth history component of the 2013 Nigerian Demographic and Health Survey. We conducted a descriptive analysis of the preventive and curative care sought and obtained for the 2,057 children aged 1–59 months who died in Nigeria and performed regional (North vs. South) comparisons.

Results

A total of 1,616 children died in the northern region, while 441 children died in the South. The majority (72.5%) of deceased children in the northern region were born to mothers who had no education, married at a young age, and lived in the poorest two quintiles of households. When caregivers first noticed that their child was ill, a median of 2 days passed before they sought or attempted to seek healthcare for their children. The proportion of children who reached and departed from their first formal healthcare provider alive was greater in the North (30.6%) than in the South (17.9%) (p<0.001). A total of 548 children were moderately or severely sick at discharge from the first healthcare provider, yet only 3.9%-18.1% were referred to a second healthcare provider. Cost, lack of transportation, and distance from healthcare facilities were the most commonly reported barriers to formal care-seeking behavior.

Conclusions

Maternal, household, and healthcare system factors contributed to child mortality in Nigeria. Information regarding modifiable social factors may be useful in planning intervention programs to promote child survival in Nigeria and other low-income countries in sub-Saharan Africa.

Inequalities in health care utilization for common childhood illnesses in Ethiopia: evidence from the 2011 Ethiopian Demographic and Health Survey

Background

Globally, 5.9 million children under the age of five died in 2015. More than half and almost one-third of those deaths occurred in sub-Saharan Africa and South Asia, respectively. Diarrhea and Pneumonia, which were the major causes of the problem, accounted for more than two million deaths of the world’s youngest children every year. Like other developing countries, child health services utilization is low in Ethiopia. The aim of this study was to identify the determinant factors for the inequalities in medical treatment seeking behavior for common childhood illnesses in Ethiopia.

Methods

Data were obtained from the Ethiopian Demographic and Health Survey (EDHS) 2011. All children who had diarrhea, cough, and fever in the 2 weeks preceding the survey were included. A total of 1620 children with diarrhea, 2082 with fever, and 2134 with cough were included in the analyses. Multivariate logistic regression with a 95% confidence interval, adjusted odds-ratio, and a P < 0.05 were used to determine the independent effect of each variable.

Results

Household wealth-status, maternal and paternal education, and religion were found to be associated with the inequality in the use of child health services. Respondents from households with the richest, richer, and middle wealth status had higher odds of seeking medical treatment for childhood diarrhea, cough, and fever than that of the poorest ones. Maternal and paternal educational status was also associated with medical treatment seeking behavior for childhood diarrhea and fever, respectively.

Conclusion

Household wealth and educational status of parents were possible determinant factors for the inequalities observed in health care seeking behavior. Policy interventions aimed at improving the appropriate medical treatment seeking behavior for common childhood illnesses are desirable. Practical economic policies aimed at moving those in the lower wealth quintile are essential to bridge the gap between the rich and the poor. Studies comprising qualitative and quantitative methods are recommended to further explore other determinants of health care utilization.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-017-0561-7) contains supplementary material, which is available to authorized users.

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.

Trends of diarrhoeal diseases in children under five years in the War Memorial Hospital-Navrongo, Ghana: 2010-2013

Introduction

Diarrhoea is the third leading cause of hospital morbidity in children under five years in the War Memorial Hospital (WMH). With the current changes in climate, little is known about the seasonal and spatial distribution of diarrhoeal diseases in the WMH. We determined trends of diarrhoeal diseases in children under five years in the WMH.

Methods

We reviewed secondary data of children under five years who attended the WMH and were diagnosed of diarrhoea. Diarrhoea was defined as a clinician's diagnosis of the passage of three or more watery stools a day in a child under five years in the WMH. Descriptive data analysis was done and expressed as frequencies and relative frequencies. Monthly proportions of diarrhoea and rainfall figures were presented to show seasonal distributions of cases. Geographical distribution of cases was determined using Epi Info and Arc GIS.

Results

A total of 865 diarrhoeal cases in children under five years reported to the hospital. Out of this, 425 (49.13%) were female children with 346 (40%) aged 0-11 months. The highest peak occurred in the rainy season from May to August. However, there was a weak negative relationship between diarrhoeal diseases and rainfall for the whole study period. Cases were clustered in the northeastern part of the Kassena Nankana Municipality (KNM).

Conclusion

The most affected age group was in 0-11months. Majority of cases were from the North Eastern part of the Municipality. There was seasonal variation of diarrhoeal diseases. Diarrhoeal diseases have the highest occurrence in the rainy season but an increase in rainfall does not necessarily lead to an increase in diarrhoeal cases. Intervention to reduce diarrhoea should be intensified before the rainy season and in the northeastern parts of the municipality.

Neighbourhood Determinants of Caries Experience in Preschool Children: A Multilevel Study

OBJECTIVES

To investigate the association between neighbourhood factors and decayed, missing, and filled teeth (dmft) index among preschool children.

METHODS

The sample of this cross-sectional study comprised 1,110 children (0-5 years old) clustered in 16 official neighbourhoods of Canoas city, southern Brazil. Multilevel binomial models were used to estimate the association of contextual variables at neighbourhood level (Human Development Index, average income, and public primary health care units) with two oral health outcomes: decayed teeth (dt) and missing or filled teeth (mft), after adjusting for individual variables (gender, age, maternal education, equivalent household income logarithm, household, and point of care).

RESULTS

Overall, 24.9% of the sample had dental caries experience (dmft >0), and 92.3% of the dmft was untreated caries. There was no statistical significant association (p > 0.05) of contextual characteristics with the decay component. The teeth of children living in richer areas had 2.87 (95% CI: 1.05-7.86) times more chances of being treated (mft component). Variance attributed to neighbourhood level was estimated as 5.9% (p < 0.01) and 4.1% (p = 0.17) for dt and mft, respectively, in adjusted models.

CONCLUSIONS

Intra-urban areas seem homogeneous, with small variability between neighbourhoods, having no contextual effect on untreated dental caries (dt). Contextual variables may influence treatment access (mft) through the use of dental services in preschool children.

Parental investment in child health in sub-Saharan Africa: a cross-national study of health-seeking behaviour

Parents face trade-offs between investing in child health and other fitness enhancing activities. In humans, parental investment theory has mostly been examined through the analysis of differential child outcomes, with less emphasis on the actions parents take to further a particular offspring's condition. Here, we make use of household data on health-seeking for children in a high mortality context where such behaviours are crucial for offspring survival. Using Demographic and Health Survey (DHS) data from 17 sub-Saharan African countries, we examine whether maternal factors (age, health, marital status) and child factors (birth order, health, sex, age) independently influence parental investment in health-seeking behaviours: two preventative behaviours (malaria net use and immunization) and two curative ones (treating fever and diarrhoea). Results indicate that children with lower birth order, older mothers and mothers with better health status have higher odds of investment. The effects of a child's sex and health status and whether the mother is polygynously married vary depending on the type of health-seeking behaviour (preventative versus curative). We discuss how these results square with predictions from parental investment theory pertaining to the state of mothers and children, and reflect on some potential mechanisms and directions for future research.

Socio-economic inequalities in curative health-seeking for children in Egypt: analysis of the 2008 Demographic and Health Survey

Background

The existence and magnitude of socio-economic inequalities in health-seeking behaviours for child curative care in Egypt and mechanisms underlying these associations have not been comprehensively assessed. This study examined whether socio-economic position (SEP) was associated with health-seeking behaviours for diarrhoea and acute respiratory infection (ARI) in children and explored potential mechanisms underlying these associations using mediation analysis.

Methods

Children aged under-five years living with their mothers sampled by the 2008 Egypt Demographic and Health Survey were used to estimate the prevalence of diarrhoea and ARI in the two-week period preceding the survey. If either illness was reported, three dimensions of health-seeking were examined in adjusted mediation models, separately by illness: whether medical care was sought, whether such care was timely (within one day of symptom onset), and whether it was sought from private providers. Latent variables of parental socio-cultural capital and household-level economic capital were the main exposures of interest.

Results

In the sample of 10,006 children, 8.4 % had diarrhoea and 7.6 % had ARI. Care was sought for 62.0 % of children with diarrhoea and 78.5 % with ARI; two-thirds of care-seeking for both illnesses was timely. More than 7 in 10 children who sought care were taken to private providers. Socio-cultural capital or economic capital were not independently associated with seeking care for either illness. Socio-cultural capital was positively associated with timely care-seeking, and economic capital was positively associated with private provider use in adjusted analyses for both illnesses.

Conclusions

SEP was not a strong determinant of care-seeking for diarrhoea or ARI, but there was a modest positive effect of SEP on timely receipt of care and private provider use. Further research is needed to explore perceptions of illness severity and the availability and quality of care from public and private providers.

Childhood Illness Prevalence and Health Seeking Behavior Patterns in Rural Tanzania

INTRODUCTION

This paper identifies factors influencing differences in the prevalence of diarrhea, fever and acute respiratory infection (ARI), and health seeking behavior among caregivers of children under age five in rural Tanzania.

METHODS

Using cross-sectional survey data collected in Kilombero, Ulanga, and Rufiji districts, the analysis included 1,643 caregivers who lived with 2,077 children under five years old. Logistic multivariate and multinomial regressions were used to analyze factors related to disease prevalence and to health seeking behavior.

RESULTS

One quarter of the children had experienced fever in the past two weeks, 12.0 % had diarrhea and 6.7 % experienced ARI. Children two years of age and older were less likely to experience morbidity than children under one year [ORfever = 0.77, 95 % CI 0.61-0.96; ORdiarrhea = 0.26, 95 % CI 0.18-0.37; ORARI = 0.60 95 % CI 0.41-0.89]. Children aged two and older were more likely than children under one to receive no care or to receive care at home, rather than to receive care at a facility [RRRdiarrhea = 3.47, 95 % CI 1.19-10.17 for "No care"]. Children living with an educated caregiver were less likely to receive no care or home care rather than care at a facility as compared to those who lived with an uneducated caregiver [RRRdiarrhea = 0.28, 95 % CI 1.10-0.79 for "No care"]. Children living in the wealthiest households were less likely to receive no care or home care for fever as compared to those who lived poorest households. Children living more than 1 km from health facility were more likely to receive no care or to receive home care for diarrhea rather than care at a facility as compared to those living less than 1 km from a facility [RRRdiarrhea = 3.50, 95 % CI 1.13-10.82 for "No care"]. Finally, caregivers who lived with more than one child under age five were more likely to provide no care or home care rather than to seek treatment at a facility as compared to those living with only one child under five.

CONCLUSIONS

Our results suggest that child age, caregiver education attainment, and household wealth and location may be associated with childhood illness and care seeking behavior patterns. Interventions should be explored that target children and caregivers according to these factors, thereby better addressing barriers and optimizing health outcomes especially for children at risk of dying before the age of five.

REGIONAL VARIATIONS IN INFANT AND CHILD MORTALITY IN NIGERIA: A MULTILEVEL ANALYSIS

There are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p < 0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p < 0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria.

Care seeking behaviour for children with suspected pneumonia in countries in sub-Saharan Africa with high pneumonia mortality

Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as 'appropriate' providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16-18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3-39.3) more likely to be brought for care than children from the poorest households, after controlling for the child's age, sex, caregiver's education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic responses.

Ethnic differentials in under-five mortality in Nigeria

OBJECTIVE

There are huge regional disparities in under-five mortality in Nigeria. While a region within the country has as high as 222 under-five deaths per 1000 live births, the rate is as low as 89 per 1000 live births in another region. Nigeria is culturally diverse as there are more than 250 identifiable ethnic groups in the country; and various ethnic groups have different sociocultural values and practices which could influence child health outcome. Thus, the main objective of this study was to examine the ethnic differentials in under-five mortality in Nigeria.

DESIGN

The study utilized 2008 Nigeria Demographic and Health Survey (NDHS) data. We analyzed data from a nationally representative sample drawn from 33,385 women aged 15-49 that had a total of 104,808 live births within 1993-2008. In order to examine ethnic differentials in under-five mortality over a sufficiently long period of time, our analysis considered live births within 15 years preceding the 2008 NDHS. The risks of death in children below age five were estimated using Cox proportional regression analysis. Results were presented as hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

The study found substantial differentials in under-five mortality by ethnic affiliations. For instance, risks of death were significantly lower for children of the Yoruba tribes (HR: 0.39, CI: 0.37-0.42, p < 0.001), children of Igbo tribes (HR: 0.58, CI: 0.55-0.61, p < 0.001) and children of the minority ethnic groups (HR: 0.66, CI: 0.64-0.68, p < 0.001), compared to children of the Hausa/Fulani/Kanuri tribes. Besides, practices such as plural marriage, having higher-order births and too close births showed statistical significance for increased risks of under-five mortality (p < 0.05).

CONCLUSION

The findings of this study stress the need to address the ethnic norms and practices that negatively impact on child health and survival among some ethnic groups in Nigeria.

Utilization of health care services for childhood morbidity and associated factors in India: a national cross-sectional household survey

Background

Information about utilization of health services and associated factors are useful for improving service delivery to achieve universal health coverage.

Methods

Data on a sample of ever-married women from India Demographic and Health survey 2005–06 was used. Mothers of children aged 0–59 months were asked about child’s illnesses and type of health facilities where treatment was given during 15 days prior to the survey date. Type of health facilities were grouped as informal provider, public provider and private provider. Factors associated with utilization of health services for diarrhea and fever/cough was assessed according to Andersen’s health behavior model. Multinomial logistic regression analyses were done considering sampling weights for complex sampling design.

Results

A total of 48,679 of ever-married women reported that 9.1% 14.8% and 17.67% of their children had diarrhea, fever and cough respectively. Nearly one-third of the children with diarrhea and fever/cough did not receive any treatment. Two-thirds of children who received treatment were from private health care providers (HCPs). Among predisposing factors, children aged 1–2 years and those born at health facility (public/private) were more likely to be taken to any type of HCP during illness. Among enabling factors, as compared to poorer household, wealthier households were 2.5 times more likely to choose private HCPs for any illness. Children in rural areas were likely to be taken to any type of HCP for diarrhea but rural children were less likely to utilize private HCP for fever/cough. ‘Need’ factors i.e. children having severe symptoms were 2–3 times more likely to be taken to any type of HCP.

Conclusion

Private HCPs were preferred for treatment of childhood illnesses. Involvement of private HCPs may be considered while planning child health programs. Health insurance scheme for childhood illnesses may to protect economically weaker sections from out-of-pocket health expenditure during child illness.

Treatment of diarrhoea in rural African communities: an overview of measures to maximise the medicinal potentials of indigenous plants

Diarrhoea is a major cause of morbidity and mortality in rural communities in Africa, particularly in children under the age of five. This calls for the development of cost effective alternative strategies such as the use of herbal drugs in the treatment of diarrhoea in these communities. Expenses associated with the use of orthodox medicines have generated renewed interest and reliance on indigenous medicinal plants in the treatment and management of diarrhoeal infections in rural communities. The properties of many phenolic constituents of medicinal plants such as their ability to inhibit enteropooling and delay gastrointestinal transit are very useful in the control of diarrhoea, but problems such as scarcity of valuable medicinal plants, lack of standardization of methods of preparation, poor storage conditions and incertitude in some traditional health practitioners are issues that affect the efficacy and the practice of traditional medicine in rural African communities. This review appraises the current strategies used in the treatment of diarrhoea according to the Western orthodox and indigenous African health-care systems and points out major areas that could be targeted by health-promotion efforts as a means to improve management and alleviate suffering associated with diarrhoea in rural areas of the developing world. Community education and research with indigenous knowledge holders on ways to maximise the medicinal potentials in indigenous plants could improve diarrhoea management in African rural communities.

FAIRNESS OF UTILIZING HEALTH CARE FACILITIES AND OUT-OF-POCKET PAYMENT BURDEN: EVIDENCE FROM CAMBODIA

Catastrophic spending on health care through out-of-pocket payment is a huge problem in most low- and middle-income countries all over the world. The collapse of health systems and poverty have resulted in the proliferation of the private health sector in Cambodia, but very few studies have examined the fairness in ease of utilization of these services based on mode of payment. This study examined the utilization of health services for sickness or injury and identified its relationship with people's ability to pay for treatment seeking at various instances. Based on cross-sectional data from the Cambodian 2007 Demographic and Health Survey, the economic index estimated through principal component analysis and Lorenz curve was used to quantify the degree of fairness and equality in utilization and payment burden among the respondents. A distinct level of fairness was found in health care utilization and out-of-pocket payments. Specifically, use of private health care facilities and over-the-counter remedies dominate, and out-of-pocket payments cut across all socioeconomic strata. As many countries in low- and middle-income regions, and most importantly those in transition such as Cambodia, are repositioning their health systems, efforts should be made towards maintaining equitable access through adoption of finance mechanisms that make utilization of health care services fair and equitable.

Progress in pediatrics in 2011. Choices in endocrinology, gastroenterology, hemato-oncology, infectious diseases, otolaryngology, pharmacotherapy and respiratory tract illnesses

Main progresses in endocrinology, gastroenterology, hemato-oncology, infectious diseases, otolaryngology, pharmacotherapy, and respiratory tract illnesses selected from articles published in The Italian Journal of Pediatrics in 2011 were reviewed. Risk factors for gastroenteritis and appendicitis in developing countries may be useful in improving our understanding of these diseases. Childhood hearing impairment is a world-wide problem which continues to have an high prevalence in newborns. Among the mechanisms of diseases, obese children often have asthma and high hepcidin levels that may reduce serum iron concentrations. In cystic fibrosis, 18q distal deletion has been described as a novel mutation. Hypothyroidism in children with central nervous system infections may increase mortality rates. Infrared tympanic thermometer (IRTT) in oral mode for the measurement of body temperature may be useful in fever screening in a busy setup. In newborns, the transmission of CMV infection through breast milk may be prevented through freezing or pasteurization. Recent advances in treatment of constipation, urinary tract infections, leukemia, pain in children with cancer, neonates with sepsis or difficult weaning from mechanical ventilation will likely contribute towards optimizing management of these common disorders. The work of the Family Pediatricians Medicines for Children Research Network aims to develop competence, infrastructure, networking and education for pediatric clinical trials.