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

Maternal Decision-Making Power and Care-Seeking Behaviors for Acutely Ill Children: A Multilevel Analysis of 33 Sub-Saharan African Countries

Timely and appropriate healthcare seeking is crucial to reduce child mortality. However, rates of care seeking for acute childhood diseases remain low in sub-Saharan Africa (SSA). This study investigated the association between maternal decision-making power and care-seeking behaviors for children with diarrhea and acute respiratory infection (ARI) in SSA. Demographic and Health Surveys from 33 SSA countries were used in a sample of mother-child pairs (mothers aged 15-49 years; children aged 0-59 months) with a recent child episode of diarrhea (N = 41,729) and ARI (N = 71,966). Maternal decision-making power was defined as making decisions on all four familial topics alone or jointly with the husband/partner. Care-seeking behaviors were measured as seeking care from health providers, other types of providers, and any providers (including both). Multivariable three-level logistic regressions were conducted. Approximately 60% of the sample sought care from any provider (46-48% from health providers versus 13-14% from others). Approximately 28% of mothers had high decision-making power. After adjusting for sociodemographic characteristics, high maternal decision-making power was associated with higher likelihood of seeking care from a health provider for both diarrhea (adjusted odds ratio [aOR] = 1.06, 95% CI = 1.01-1.12) and ARI (aOR = 1.07, 95% CI = 1.03-1.11) and lower likelihood of seeking care from others (aOR = 0.89, 95% CI = 0.82-0.97 for diarrhea; aOR = 0.88, 95% CI = 0.82-0.94 for ARI). Maternal decision-making power was positively associated with their care-seeking behaviors from health providers for acutely ill children in SSA. Women's empowerment interventions that particularly increase women's agency in decision-making may holistically improve health and well-being of the next generation.

Magnitude and determinant of healthcare-seeking behavior for childhood acute respiratory tract infections in Ethiopia: a cross-sectional study

BACKGROUND

Acute respiratory infections (ARIs) remain a major public health concern which become the leading cause of mortality and morbidity in children under the age of five. A large percentage of childhood deaths and complications can be avoided by seeking proper medical care. Therefore, this study aimed to assess the magnitude, and individual and community-level determinants of mothers' healthcare-seeking behavior for their children under the age of five who had ARI symptoms in Ethiopia.

METHOD

A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Surveys(EDHS) with a total weighted sample of 643 under-five children who had ARI symptoms within two weeks of the survey. Due to the hierarchical nature of the EDHS data, a multi-level logistic regression model was used to identify the individual and community-level factors influencing mothers' health care-seeking behavior for their children with ARI symptoms. In the multivariable multilevel analysis, those variables with a p-value < 0.05 were considered to be significant predictors of the outcome variable.

RESULTS

Healthcare-seeking behavior among mothers or caregivers for children with symptoms of ARIs was 32.61% (95% CI: 29.08-36.33%) in Ethiopia. The ICC in the null model indicated that about 55% of the total variability of treatment-seeking behavior was due to differences between clusters. Child aged > 24 months [AOR = 0.35; 0.19-0.63], having primary education [AOR = 3.25; 1.27-8.32], being media exposed [AOR = 2.49; 1.15, 5.38], female household head[AOR = 3.90; 1.35, 11.24], and delivery at health institution[AOR = 2.24; 1.00, 5.01] were significant predictors of health care seeking behavior of mother for their children with ARI symptoms.

CONCLUSION

There is poor treatment-seeking behavior for children with symptoms of ARI in Ethiopia with significant community level variations. The multilevel logistic regression analysis showed that improving mothers' education, women's empowerment, facilitating institutional delivery and media accessibility are critical to promoting health-seeking behaviors among mothers or caregivers of under-five children with ARI symptoms. Hence, concerned bodies should design targeted interventions that increase mothers' or caregivers' treatment-seeking behavior for childhood ARI to reduce child morbidity and mortality.

Factors associated with mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa: a multilevel robust Poisson regression modelling

BACKGROUND

Timely and appropriate treatment for childhood illness saves the lives of millions of children. In low-middle-income countries such as sub-Saharan Africa (SSA), poor healthcare-seeking behavior for childhood illnesses is identified as a major contributor to the increased risk of child morbidity and mortality. However, studies are limited on Factors associated with mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa.

OBJECTIVE

To examine factors associated with a mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in sub-Saharan Africa.

METHODS

A secondary data analysis was conducted based on the latest Demographic and Health Survey (DHS) data of 36 sub-Saharan African countries. A total weighted sample of 16,925 mothers who had under-five children with acute respiratory infection symptoms was considered. The Intraclass Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR) tests were done to assess the presence of clustering. Model comparison was made based on deviance (-2LLR) value. Variables with a p-value < 0.2 in the bivariable multilevel robust Poisson analysis were considered for the multivariable analysis. In the multivariable multilevel robust Poisson regression analysis, the Adjusted Prevalence Ratio (APR) with the 95% Confidence Interval (CI) was reported to declare the statistical significance and strength of the association.

RESULTS

The prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children in SSA was 64.9% (95% CI: 64.2%, 65.7%). In the multivariable analysis; mothers who attained primary education (APR = 1.11, 95% CI: 1.08, 1.15), secondary education (APR = 1.13, 95% CI: 1.09, 1.18), and higher education (APR = 1.19, 95% CI: 1.11, 1.27), belonged to the richest household (APR = 1.07: 95% CI: 1.02, 1.12), had media exposure (APR = 1.11, 95% CI: 1.08, 1.15), currently working (APR = 1.08, 95% CI: 1.06, 1.11), had ANC use (APR = 1.25: 95% CI: 1.17, 1.35), health facility delivery (APR = 1.10, 95% CI: 1.07, 1.14), belonged to West Africa (APR = 1.04, 95% CI: 1.01, 1.08) and being in the community with high media exposure (APR = 1.04, 95% CI: 1.02, 1,07) were significantly associated with higher prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children. On the other hand, distance to a health facility (APR = 0.87, 95% CI: 0.84, 0.91), and being in central Africa (APR = 0.87, 95% CI: 0.84, 0.91) were significantly associated with a lower prevalence of mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children.

CONCLUSION

Mother's healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children. It was influenced by maternal education, maternal working status, media exposure, household wealth status, distance to the health facility, and maternal health care service use. Any interventions aiming at improving maternal education, maternal healthcare services, and media access are critical in improving mothers' healthcare-seeking behavior for symptoms of acute respiratory infection in under-five children, hence lowering the prevalence of ARI-related death and morbidity.

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.

Drivers of informal sector and non-prescription medication use in pediatric populations in a low- and middle-income setting: A prospective cohort study in Zambia

Obtaining medication from the informal sector is common in low- and middle- income countries. Informal sector use increases the risk for inappropriate medication use, including inappropriate antibiotic usage. Infants are at the highest risk of complications from inappropriate medication use, yet there is insufficient knowledge about the risk factors driving caregivers to obtain medication from the informal sector for young children. We aimed to define infant and illness characteristics associated with use of medication purchased in the informal sector for infants up to fifteen months of age in Zambia. We used data from, a prospective cohort study (ROTA-biotic) conducted among 6 weeks to 15 months old children in Zambia, which is nested within an ongoing phase III rotavirus vaccine trial (Clinicaltrial.gov NCT04010448). Weekly in-person surveys collected information about illness episodes and medication usage for the trial population and for a community control cohort. The primary outcome for this study was whether medication was purchased in the formal sector (hospital or clinic) or informal sector (pharmacy, street vendor, friend/relative/neighbor, or chemical shop) per illness episode. Descriptive analyses were used to describe the study population, and the independent and medication use variables stratified by the outcome. A mixed-effects logistic regression model with a participant-level random intercept was used to identify independent variables associated with the outcome. The analysis included 439 participants accounting for 1927 illness episodes over fourteen months in time. Medication was purchased in the informal sector for 386 (20.0%) illness episodes, and in the formal sector for 1541 (80.0%) illness episodes. Antibiotic usage was less common in the informal sector than in the formal sector (29.3% vs 56.2%, p < 0.001, chi-square). Most medications purchased in the informal sector were orally administered (93.4%), and non-prescribed (78.8%). Increased distance from the closest study site (OR: 1.09; 95% CI: 1.01, 1.17), being included in the community cohort site (OR: 3.18; 95% CI: 1.86, 5.46), illnesses with general malaise fever, or headache (OR: 2.62; 95% CI: 1.75, 3.93), and wound/skin disease (OR: 0.36; 95% CI: 0.18, 0.73) were associated with use of medication from the informal sector. Sex, socioeconomic status, and gastrointestinal disease were not associated with use of medication from the informal sector. Informal sector medication use is common and, in this study, risk factors for obtaining medications in the informal sector included a long distance to a formal clinic, type of illness, and not being enrolled in a clinical trial. Continued research on medication use from the informal sector is crucial and should include generalizable study populations, information on severity of disease, emphasis on qualitative research, and a move towards testing interventions that aim to improve access to formal health care settings. Our findings suggest that improved access to formal health care services may decrease reliance on medication from the informal sector for infants.

The use of traditional medicine practitioner services for childhood illnesses among childbearing women: a multilevel analysis of demographic and health surveys in 32 sub-Saharan African countries

BACKGROUND

Insights into the use of traditional medicine practitioners (TMP)-for common childhood diseases such as diarrhea and respiratory infections are important to understand the role of Traditional Medicine (TM) in reducing the increasing childhood morbidity and mortality in sub-Saharan Africa (SSA). However, a comprehensive picture of TMP utilisation and its associated factors for childhood illness in SSA is lacking. This study aimed to estimate the prevalence of the use of traditional medicine practitioner services to treat childhood illnesses among women with children under five years old and to identify individual and community-level factors associated with TMP use in SSA.

METHODS

The analysis used Demographic and Health Surveys (DHS) dataset collected between 2010 and 2021 among 353,463 under-fives children from 32 SSA countries. Our outcome variable was the use of TMP for childhood illness, defined as having diarrhoea or fever/cough or both. Using STATA v14, we employed the random effect meta-analysis to estimate the pooled prevalence of TMP use for childhood illness and a two-level multivariable multilevel modelling to determine the individual and community-level factors associated with consultation of a TMP.

RESULTS

Approximately [2.80% (95%CI: 1.88-3.90)] women who sought healthcare for childhood illnesses utilised the service of a TMP with the highest occurring in Cote d'Ivoire [16.3% (95%CI: 13.87-19.06)] and Guinea (13.80% (95%CI: 10.74-17.57)] but the lowest in Sierra Leone [0.10%(95%CI:0.01-1.61)]. Specifically, approximately [1.95% (95%CI: 1.33-2.68)] and [1.09% (95%CI:0.67-1.60)] of women sought the service of a TMP for childhood diarrhea and fever/cough, respectively. Women with no formal education [AOR = 1.62;95%CI:1.23-2.12], no media access [AOR = 1.19;95%CI:1.02-1.39), who lived in a male-headed household [AOR = 1.64;95%CI:1.27-2.11], without health insurance [AOR = 2.37;95%CI: 1.53-3.66], who considered it a problem getting permission to visit a health facility [AOR = 1.23;95%CI:1.03-1.47] and who perceived the size of their children at birth to be above average[AOR = 1.20;95%CI:1.03-1.41] had higher odds of using TMP for childhood illnesses.

CONCLUSIONS

Although the prevalence of TMP for childhood illnesses appeared low, our findings highlight that TMPs continue to play a critical role in managing childhood illnesses in SSA. It is essential that policymakers and service providers should incorporate the potential role of TMPs in the design, review and implementation of child health policies in SSA. Also, the interventions for curtailing childhood illnesses should be focused on the characteristics of women who use TMPs for childhood diseases identified in our study.

Ear, Nose and Throat (ENT) disease diagnostic error in low-resource health care: Observations from a hospital-based cross-sectional study

Although the global burden of ear, nose and throat (ENT) diseases is high, data relating to ENT disease epidemiology and diagnostic error in resource-limited settings remain scarce. We conducted a retrospective cross-sectional review of ENT patients' clinical records at a resource-limited tertiary hospital. We determined the diagnostic accuracy and appropriateness of patient referrals for ENT specialist care using descriptive statistics. Cohens kappa coefficient (κ) was calculated to determine the diagnostic agreement between non-ENT clinicians and the ENT specialist, and logistic regression applied to establish the likelihood of patient misdiagnosis by non-ENT clinicians. Of the 1543 patients studied [age 0-87 years, mean age 25(21) years (mean(SD)], non-ENT clinicians misdiagnosed 67.4% and inappropriately referred 50.4%. Compared to those aged 0-5 years, patients aged 51-87 years were 1.77 (95%CI: 1.03-3.04) fold more likely to have a referral misdiagnosis for specialist care. Patients with ear (aOR: 1.63; 95% CI: 1.14-2.33) and those with sinonasal diseases (aOR: 1.80; 95% CI: 1.14-2.45) had greater likelihood of referral misdiagnosis than those with head and neck diseases. Agreement in diagnosis between the ENT specialist and non-ENT clinicians was poor (κ = 0.0001). More effective, accelerated training of clinicians may improve diagnostic accuracy in low-resource settings.

Maternal mental well-being and recent child illnesses-A cross-sectional survey analysis from Jigawa State, Nigeria

Child health indicators in Northern Nigeria remain low. The bidirectional association between child health and maternal well-being is also poorly understood. We aim to describe the association between recent child illness, socio-demographic factors and maternal mental well-being in Jigawa State, Nigeria. We analysed a cross-sectional household survey conducted in Kiyawa local government area, Jigawa State, from January 2020 to March 2020 amongst women aged 16-49 with at least one child under-5 years. We used two-stage random sampling. First, we used systematic random sampling of compounds, with the number of compounds based on the size of the community. The second stage used simple random sampling to select one eligible woman per compound. Mental well-being was assessed using the Short Warwick-Edinburgh Mental Wellbeing Score (SWEMWBS). We used linear regression to estimate associations between recent child illness, care-seeking and socio-demographic factors, and mental well-being. Overall 1,661 eligible women were surveyed, and 8.5% had high mental well-being (metric score of 25.0-35.0) and 29.5% had low mental well-being (metric score of 7.0-17.9). Increasing wealth quintile (adj coeff: 1.53; 95% CI: 0.91-2.15) not being a subsistence farmer (highest adj coeff: 3.23; 95% CI: 2.31-4.15) and having a sick child in the last 2-weeks (adj coeff: 1.25; 95% CI: 0.73-1.77) were significantly associated with higher mental well-being. Higher levels of education and increasing woman's age were significantly associated with lower mental well-being. Findings contradicted our working hypothesis that a recently sick child would be associated with lower mental well-being. We were surprised that education and late marriage, which are commonly attributed to women's empowerment and autonomy, were not linked to better well-being here. Future work could focus on locally defined tools to measure well-being reflecting the norms and values of communities, ensuring solutions that are culturally acceptable and desirable to women with low mental well-being are initiated.

Socio-economic disadvantage and quality Antenatal Care (ANC) in Sierra Leone: Evidence from Demographic and Health Survey

INTRODUCTION

Reduction of maternal mortality remains a global priority as highlighted by the third Sustainable Development Goal (SDG). This is critical in the case of Sierra Leone as the country is one of three (3) countries with the highest maternal mortality ratio globally, thus 1,120 per 100,000 live births. The approximate lifetime risk of maternal mortality in the country is 1 in 17, relative to 1 in 3,300 in high-income countries. These raise doubt about the quality of the continuum of maternal healthcare in the country, particularly antenatal care and as a result, the objective of the present study is to investigate the association between socio-economic disadvantage and quality antenatal care service utilisation as well as associated correlates in Sierra Leone.

MATERIALS AND METHODS

The study used data from the most recent Demographic and Health Survey (DHS) of Sierra Leone. Only women who had given birth in the five years preceding the survey were included, which is 6,028. Quality antenatal care was defined as receipt of recommended ANC services including uptake of recommended pregnancy drugs (e.g. Fansidar and iron supplement); injections (e.g. tetanus injection) and having some samples (e.g. blood and urine sample) and health status indicators (e.g. blood pressure) taken. An index was created from these indicators with scores ranging from 0 to 6. The scores 0 to 5 were labelled as "incomplete" and 6 was labelled as "complete" and this was used to create a dummy variable. In analysing the data, descriptive analysis was done using chi-square test as well as an inferential analysis using bivariate and multivariate models.

RESULTS

Socio-economic disadvantaged [1.46 (1.09, 1.95), place of residence [2.29 (1.43, 3.67)], frequency of listening to radio [1.58 (1.20, 2.09)], health insurance coverage [3.48 (1.40, 8.64)], getting medical help for self: permission to go [0.53(0.42, 0.69) were seen to have significant relationship with quality of ANC utilized by women during pregnancy. Also, women Mende ethnicity are more likely to utilise quality ANC compared to women from the Temne ethnicity [2.58 (1.79, 3.72)].

CONCLUSION

Policy makers could consider measures to boost patronage of quality ANC in Sierra Leone by targeting the socio-economically disadvantaged women. Targeting these sub-groups with pro- maternal and child health (MCH) interventions would help Sierra Leone achieve Goal 3 of the SDGs.

Prevalence and predictors of oral rehydration therapy, zinc, and other treatments for diarrhoea among children under-five in sub-Saharan Africa

Background

Despite the evidence-based effectiveness of diarrhoea treatment in preventing diarrhoea-related child mortality, the accessibility and utilization of diarrhoea treatments remain low in sub-Saharan Africa, even though these treatments are available. Therefore, this study aimed to assess the prevalence and predictors of diarrhoea treatment among under-five children in sub-Saharan Africa.

Methods

This study involved cross-sectional analyses of secondary data from the most recent Demographic and Health Surveys of 30 countries in sub-Saharan Africa. Percentages with their respective 95% confidence intervals (CI) were used to summarise the prevalence of diarrhoea treatment. A multivariable multilevel binary logistic regression analysis was employed to examine the predictors of diarrhoea treatment among children under five years in sub-Saharan Africa. The regression results were presented using adjusted odds ratio with their accompanying 95% confidence intervals. Statistical significance was set at p<0.05. Stata software version 16.0 was used for the analyses.

Results

The overall prevalence of diarrhoea treatment among under-five children in sub-Saharan Africa was 49.07% (95% CI = 44.50–53.64). The prevalence of diarrhoea treatment ranged from 23.93% (95% CI = 20.92–26.94) in Zimbabwe to 66.32% (95% CI = 61.67–70.97) in Liberia. Children aged 1 to 4 years, those whose mothers had at least primary education, those whose mothers had postnatal care visits, those whose mothers believed that permission to go and get medical help for self was a big problem, and those whose mothers’ partners had at least primary education were more likely to undergo diarrhoea treatment as compared to their counterparts. The odds of diarrhoea treatment increased with increasing wealth index with the highest odds among those in the richest quintile. Also, the odds of diarrhoea treatment was higher in the Central, Eastern, and Western geographical subregions compared to those in the Southern geographical subregion. However, children whose mothers were cohabiting, those whose mothers were exposed to watching television, and those living in female-headed households were less likely to undergo diarrhoea treatment.

Conclusion

The study found that the prevalence of diarrhoea treatment among children in sub-Saharan Africa was relatively low and varied across countries. The sub-regional estimates of diarrhoea treatment and identified associated factors can support country-specific needs assessments targeted at improving policy makers’ understanding of within-country disparities in diarrhoea treatment. Planned interventions (e.g., provision of quality and affordable supply of oral rehydration salts and zinc) should seek to scale up diarrhoea treatment uptake among under-five children in sub-Saharan Africa with much focus on the factors identified in this study.

Care Seeking and Treatment of Febrile Children with and without Danger Signs of Severe Disease in Northern Uganda: Results from Three Household Surveys (2018-2020)

Identification, stabilization, and prompt referral of children with signs of severe febrile disease (danger signs) in rural communities are crucial for preventing complications and death from severe malaria, pneumonia, and diarrhea. We set out to determine the treatment-seeking practices and treatment patterns for children < 5 years of age with an acute febrile illness, with or without danger signs of severe disease, in a highly malaria-endemic area of northern Uganda. Three household surveys were conducted from November through December each year in 2018, 2019, and 2020. Overall, 30% of the children in the study were reported to have had a WHO-classified danger sign including convulsions, unconsciousness/unusually sleepy, inability to feed or drink, and vomiting everything. Only half of the children in this study sought care from a health provider. However, significantly more children with danger signs of severe disease sought and received treatment and diagnostics from a health provider, compared with those without danger signs (adjusted odds ratio: 1.6, 95% confidence interval: 1.2-2.0; P < 0.01). In the total population studied, care seeking in the public sector was 26% and similar to care seeking in the private sector (24%). Community health workers were used as the first source of care by 12% of the children. Approximately 38% of the children who were reported to have danger signs of severe disease requiring prompt referral and treatment did not seek care from a health provider. Understanding and addressing barriers to accessing healthcare could contribute to better treatment seeking practices.

Programmatic adaptations to acute malnutrition screening and treatment during the COVID-19 pandemic

The COVID-19 pandemic presented numerous challenges to acute malnutrition screening and treatment. To enable continued case identification and service delivery while minimising transmission risks, many organisations and governments implemented adaptations to community-based management of acute malnutrition (CMAM) programmes for children under 5. These included: Family mid-upper arm circumference (MUAC); modified admission and discharge criteria; modified dosage of therapeutic foods; and reduced frequency of follow-up visits. This paper presents qualitative findings from a larger mixed methods study to document practitioners' operational experiences and lessons learned from these adaptations. Findings reflect insights from 37 interviews representing 15 organisations in 17 countries, conducted between July 2020 and January 2021. Overall, interviewees indicated that adaptations were mostly well-accepted by staff, caregivers and communities. Family MUAC filled screening gaps linked to COVID-19 disruptions; however, challenges included long-term accuracy of caregiver measurements; implementing an intervention that could increase demand for inconsistent services; and limited guidance to monitor programme quality and impact. Modified admission and discharge criteria and modified dosage streamlined logistics and implementation with positive impacts on staff workload and caregiver understanding of the programme. Reduced frequency of visits enabled social distancing by minimising crowding at facilities and lessened caregivers' need to travel. Concerns remained about how adaptations impacted children's identification for and progress through treatment and programme outcomes. Most respondents anticipated reverting to standard protocols once transmission risks were mitigated. Further evidence, including multi-year programmatic data analysis and rigorous research, is needed in diverse contexts to understand adaptations' impacts, including how to ensure equity and mitigate unintended consequences.

Barriers to healthcare access and healthcare seeking for childhood illnesses among childbearing women in Burundi

Introduction

Poor health seeking behaviour continues to be major challenge in accessing healthcare in sub-Saharan Africa despite the availability of effective treatment for most childhood illnesses. The current study investigated the barriers to healthcare access and health seeking for childhood illnesses in Burundi.

Methods

The study utilized data from the 2016–17 Burundi Demographic and Health Survey (BDHS). A total of 2173 children under five of childbearing women were included in our study. The outcome variable for the study was healthcare seeking for childhood illnesses (diarrhea and fever/cough). Barriers to healthcare access were the explanatory variables and maternal and child factors were the control variables. Chi-square test of independence and a binary logistic regression modelling were carried out to generate the results.

Results

Overall, less than 50% of children in Burundi who were ill two weeks before the survey obtained healthcare. We found that children of mothers who perceived getting money for medical care for self as a big problem [aOR = 0.75; CI = 0.60–0.93] and considered going for medical care alone as a big problem [aOR = 0.71; CI = 0.55–0.91] had lower odds of getting healthcare, compared to those of mothers who considered these indicators as not a big problem. The results also showed that children of mothers who had three [aOR = 1.48; 1.02–2.15] and four [aOR = 1.62; 1.10–2.39], children were more likely to get healthcare for childhood illnesses compared to those whose mothers had one child. Children of mothers with single birth children were less likely to get healthcare compared to those whose mothers had multiple births.

Conclusion

Findings of the low prevalence of healthcare for childhood illnesses in Burundi suggest the need for government and non-governmental health organizations to strengthen women’s healthcare accessibility for child healthcare services and health seeking behaviours. The Burundian government through multi-sectoral partnership should strengthen health systems for maternal health and address structural determinants of women’s health by creating favourable conditions to improve the status of women and foster their overall socioeconomic well-being. Free child healthcare policies in Burundi should be strengthened to enhance the utilization of child healthcare services in Burundi.

Determinants of care-seeking behaviour for fever, acute respiratory infection and diarrhoea among children under five in Nigeria

Background

Despite available, inexpensive and effective treatments, malaria, diarrhoea, and pneumonia still contribute the majority of the global burden of childhood morbidity and mortality. Nigeria has the highest absolute numbers of child deaths worldwide. Appropriate care-seeking is important for prompt diagnosis, appropriate and timely treatment, and prevention of complications. The objective of this cross-sectional study was to examine the prevalence of and factors associated with appropriate care-seeking for childhood illnesses.

Methods

We used the most recent Nigeria Demographic and Health Survey (2018) to assess the prevalence of appropriate care-seeking among mothers of children under five with symptoms of common childhood illnesses. For diarrhoea, we defined appropriate care-seeking as seeking care from a formal health provider. For fever and acute respiratory infection (ARI), appropriate care-seeking was defined as seeking care from a formal provider the day of or after symptom onset. Multivariate logistic regression was carried out to assess factors associated with optimal care-seeking for each illness.

Results

At least 25% of parents did not seek any care for children with fever or ARI; this figure was over one third for diarrhoea. Only 15% and 13% of caregivers showed appropriate care-seeking for their children with fever and ARI respectively, and 27% of mothers sought care from a formal provider for diarrhoea. Predictors of appropriate care-seeking varied according to childhood illness. Previous facility delivery was the only risk factor associated with increased odds of appropriate care-seeking for all three illnesses; other risk factors varied between illnesses.

Conclusion

Overall, care-seeking for childhood illnesses was suboptimal among caregivers in Nigeria. Interventions to increase caregivers’ awareness of the importance of appropriate care-seeking are needed alongside quality of care interventions that reinforce people’s trust in formal health facilities, to improve timely care-seeking and ultimately reduce the high burden of child deaths in Nigeria.

Risk factors associated with non-vaccination in Gambian children: a population-based cohort study

BACKGROUND

We determined the risk factors associated with unvaccinated children in rural Gambia.

METHODS

We conducted prospective demographic surveillance and recorded immunisations in real time in the Upper River Region, The Gambia. Analysis included residents born from 1 January 2012 to 31 December 2016. Data included age, sex, household members and relationships, migrations, births, deaths, ethnicity, residential location and birth type. Children were defined as unvaccinated at 10, 15 and 24 mo of age if they missed all primary series doses (pentavalent, oral polio and pneumococcal conjugate vaccines), secondary series (first dose measles and yellow fever vaccines) or both vaccination series, respectively. Logistic regressions measured the association between risk factors and being unvaccinated.

RESULTS

In total, 5% (1567/30 832) of infants born during the study period and who were residents at the age of 10 mo were unvaccinated. Being unvaccinated at 10 mo of age was associated with children; who did not reside with either parent (adjusted OR 2.26, 95% CI 1.60 to 3.19), whose parents were not the head of household (1.29, 1.09 to 1.52), who had experienced immigration (2.78, 1.52 to 5.08) or who were not of Mandinka ethnicity (between 1.57 and 1.85 for other ethnicities).

CONCLUSIONS

Family characteristics are associated with unimmunised children in rural Gambia. Our findings may inform strategies to increase vaccine coverage.

Influence of sub-national social health insurance scheme on enrollees' health seeking behaviour in Anambra state, Nigeria: a pre and post study

Background

Appropriate health-seeking behaviour (HSB) is crucial for improving health outcomes and achieving universal health coverage (UHC). Accessing healthcare through the state social health insurance scheme (SSHIS) could lead to improved HSB. The study explores the influence of access to healthcare through health insurance on the HSB of the enrollees of the SSHIS in southeast, Nigeria.

Methods

A descriptive cross-sectional study undertaken in twelve health facilities in Anambra state using quantitative and qualitative research methods. Data were collected through a facility-based survey (n = 447) and sex-disaggregated focus group discussions (n = 12) of health insurance enrollees. Univariate and bivariate analyses were performed for quantitative data, while qualitative data were analyzed using a manual content approach.

Result

The findings revealed a positive change in enrollee’s HSB post-health insurance enrollment. Majority (83%) of the respondents reported that they immediately take action when ill post-health insurance enrollment as against 34% (pre-health insurance) resulting in a 49% increase, with a statistically significant difference (p < 0.02). There was a statistically significant association between positive HSB and marital status (p < 0.04); educational level (p < 0.00); occupation (p < 0.03) and ownership of health facility (p < 0.00). There was an increase in the percentage of enrollees who use the hospital as their first choice of provider during an illness episode post-health insurance enrollment. This increased from 37.4% to 90.2% (post-health insurance enrollment), representing a 52.8% increase, which is statistically significant (p < 0.03), in seeking care in hospitals. Similarly, the percentage (46%) of enrollees using patent medicine vendors (PMVs) as their first choice of provider when ill prior to enrollment in health insurance decreased to 8.1% post-health insurance enrollment, representing a 38% decline with a statistically significant (p < 0.00) drop in PMV patronage. Reasons for positive HSB include low cost of services and availability of quality care such as quality drugs, presence of doctors, and other skilled health workers by the health insurance facilities.

Conclusion

Health insurance has been established as an effective strategy for improving appropriate HSB. Hence, increasing coverage of health insurance among the uninsured is crucial in improving access to quality and affordable health care towards achieving UHC, particularly in developing countries.

Associations between women’s empowerment, care seeking, and quality of malaria care for children: A cross-sectional analysis of demographic and health surveys in 16 sub-Saharan African countries

Background

Methods

Results

Conclusions

The Effect of Socio-Demographic Factors in Health-Seeking Behaviors among Bangladeshi Residents during the First Wave of COVID-19

Background: Socio-demographic variability among nations and cultures highly influences health-seeking behavior (HSB) in managing endemic or pandemic diseases. The present study aimed to investigate the influence of socio-demographic factors on HSB among Bangladeshi residents during the first wave of COVID-19. Methods: A cross-sectional online survey was performed with Bangladeshi residents (60% male and 40% female; age range: 10−60 years or above) from May to July 2020. Information was collected from the participants who resided in slum areas or did not have internet access through face-to-face surveys, maintaining spatial distancing and proper preventive measures. A self-reported and structured questionnaire, including socio-demographic and HSB, was undertaken, and the data was analyzed using a convenience sampling method. Finally, among the 947 participants, 20 were selected using a stratified random sampling technique for in-depth-interview (IDI). The linear regression analysis was performed to determine the influence of socio-demographic factors on HSB. Results: Only about 4.2% of respondents did not wear masks, but nearly half of the participants (46.6%) did not use hand gloves. The mean score of HSB was 9.98 (SD = 2.01) out of 16, with a correct overall rate of 62.4%. As per regression analysis, higher HSBs were found among participants who reported older age (>50 years) (9.96 ± 2.45), educated unemployed students (10.1 ± 1.95), higher education (10.5 ± 1.76), and higher-income (10.4 ± 1.59); in contrast, participants living in slum areas (8.18 ± 2.34) and whose source of income was business (8.46 ± 2.04) exhibited lower HSBs. Females, compared to men, showed better HSB in every aspect, apart from online food ordering. Qualitative data showed that the younger generation is more aware because of their access to information and persuaded the older generations to follow health-seeking protocols. The results also showed that some lower-income slum-dwellers have access to information and healthcare through their employers. IDIs also found cultural, religious, and mental-health affect people’s adherence to health-seeking guidelines and regulations. Conclusions: The findings suggest that socio-demographic factors significantly influenced HSBs during COVID-19 in the Bangladeshi population. Authorities can use these observations to systematically manage future endemics or pandemics.

Health care seeking behaviour for children with acute childhood illnesses and its relating factors in sub-Saharan Africa: evidence from 24 countries

BACKGROUND

Childhood illnesses and mortality rates have declined over the past years in sub-Saharan African countries; however, under-five mortality is still high in the region. This study investigated the magnitude and factors associated with health care seeking behaviour for children with childhood illnesses in 24 sub-Saharan African countries.

METHODS

We used secondary data from Demographic and Health Surveys (DHSs) conducted between 2013 and 2018 across the 24 sub-Saharan African countries. Binary logistic regression models were applied to identify the factors associated with health care seeking behaviour for children with acute childhood illnesses. The results were presented using adjusted odds ratios (aOR) with 95% confidence intervals (CIs).

RESULTS

Overall, 45% of children under-5 years with acute childhood illnesses utilized health care facilities. The factors associated with health care seeking behaviour for children with acute illnesses were sex of child, number of living children, education, work status, wealth index, exposure to media and distance to a health facility.

CONCLUSIONS

Over half of mothers did not seek appropriate health care for under-five childhood illnesses. Effective health policy interventions are needed to enhance health care seeking behaviour of mothers for childhood illnesses in sub-Saharan African countries.

Opportunities to catalyse improved healthcare access in pluralistic systems: a cross-sectional study in Haiti

OBJECTIVE

To identify determinants of intended versus actual care-seeking behaviours in a pluralistic healthcare system that is reliant on both conventional and non-conventional providers and discover opportunities to catalyse improved healthcare access.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

In Haiti 568 households (incorporating 2900 members) with children less than 5 years of age were randomly sampled geographically with stratifications for population density. These households identified the healthcare providers they frequented. Among 140 providers, 65 were located and enrolled.

OUTCOME MEASURES

Household questionnaires with standardised cases (intentions) were compared with self-recall of health events (behaviours). The connectedness of households and their providers was determined by network analysis.

RESULTS

Households reported 636 health events in the prior month. Households sought care for 35% (n=220) and treated with home remedies for 44% (n=277). The odds of seeking care increased 217% for severe events (adjusted OR (aOR)=3.17; 95% CI 1.99 to 5.05; p<0.001). The odds of seeking care from a conventional provider increased by 37% with increasing distance (aOR=1.37; 95% CI 1.06 to 1.79; p=0.016). Despite stating an intention to seek care from conventional providers, there was a lack of congruence in practice that favoured non-conventional providers (McNemar's χ² test p<0.001). Care was sought from primary providers for 68% (n=150) of cases within a three-tiered network; 25% (n=38/150) were non-conventional.

CONCLUSION

Addressing geographic barriers, possibly with technology solutions, should be prioritised to meet healthcare seeking intentions while developing approaches to connect non-conventional providers into healthcare networks when geographic barriers cannot be overcome.

A cross-sectional study on factors associated with health seeking behaviour of Malawians aged 15+ years in 2016

Introduction

Health seeking behaviour (HSB) refers to actions taken by individuals who are ill in order to find appropriate remedy. Most studies on HSB have only examined one symptom or covered only a specific geographical location within a country. In this study, we used a representative sample of adults to explore the factors associated with HSB in response to 30 symptoms reported by adult Malawians in 2016.

Methods

We used the 2016 Malawi Integrated Household Survey dataset. We fitted a multilevel logistic regression model of likelihood of ‘seeking care at a health facility’ using a forward step-wise selection method, with age, sex and reported symptoms entered as a priori variables. We calculated the odds ratios (ORs) and their associated 95% confidence intervals (95% CI). We set the level of statistical significance at P < 0.05.

Results

Of 6909 adults included in the survey, 1907 (29%) reported symptoms during the 2 weeks preceding the survey. Of these, 937 (57%) sought care at a health facility. Adults in urban areas were more likely to seek health care at a health facility than those in rural areas (AOR = 1.65, 95% CI: 1.19–2.30, P = 0.003). Females had a higher likelihood of seeking care from health facilities than males (AOR = 1.26, 95% CI: 1.03–1.59, P = 0.029). Being of higher wealth status was associated with a higher likelihood of seeking care from a health facility (AOR = 1.58, 95% CI: 1.16–2.16, P = 0.004). Having fever and eye problems were associated with higher likelihood of seeking care at a health facility, while having headache, stomach ache and respiratory tract infections were associated with lower likelihood of seeking care at a health facility.

Conclusion

This study has shown that there is a need to understand and address individual, socioeconomic and geographical barriers to health seeking to increase access and appropriate use of health care and fast-track progress towards Universal Health Coverage among the adult population.

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.

Introducing rotavirus vaccine in eight sub-Saharan African countries: a cost-benefit analysis

BACKGROUND

Stimulated by the economic challenges faced by many sub-Saharan African countries and the changes in the rotavirus burden across these countries, this study aimed to inform the decision of health policy makers of eight sub-Saharan countries, who are yet to introduce the rotavirus vaccine as of Dec 31, 2020, on the health economic consequences of the introduction of the vaccine in terms of the costs and benefits.

METHODS

We did a cost-benefit analysis using a simulation-based decision-analytic model for children aged younger than 1 year, who were followed up to 259 weeks, in the Central African Republic, Chad, Comoros, Equatorial Guinea, Gabon, Guinea, Somalia, and South Sudan. Data were collected and analysed between Jan 13, 2020, and Dec 11, 2020. Cost-effectiveness analysis and budget impact analysis were done as secondary analyses. Four rotavirus vaccinations (Rotarix, Rotateq, Rotavac, and Rotasiil) were compared with no vaccination. The primary outcome was disability-adjusted life-years averted, converted to monetary terms. The secondary outcomes include rotavirus gastroenteritis averted, and rotavirus vaccine-associated intussusception. The primary economic evaluation measure was the benefit-cost ratio (BCR).

FINDINGS

For the modelling period, Jan 1, 2021, to Dec 31, 2030, we found that the benefits of introducing the rotavirus vaccine outweighed the costs in all eight countries, with Chad and the Central African Republic having the highest BCR of 19·42 and 11·36, respectively. Guinea had the lowest BCR of 3·26 amongst the Gavi-eligible countries. Equatorial Guinea and Gabon had a narrow BCR of 1·86 and 2·06, respectively. Rotarix was the optimal choice for all the Gavi-eligible countries; Rotasiil and Rotavac were the optimal choices for Equatorial Guinea and Gabon, respectively.

INTERPRETATION

Introducing the rotavirus vaccine in all eight countries, but with caution in Equatorial Guinea and Gabon, would be worthwhile. With the narrow BCR for Equatorial Guinea and Gabon, cautious, pragmatic, and stringent measures need to be employed to ensure optimal health benefits and cost minimisation of the vaccine introduction. The final decision to introduce the rotavirus vaccine should be preceded by comparing its BCR to the BCRs of other health-care projects.

FUNDING

Copenhagen Consensus Center and the Bill & Melinda Gates Foundation.

Health knowledge and care seeking behaviour in resource-limited settings amidst the COVID-19 pandemic: A qualitative study in Ghana

BACKGROUND

The emergence of a pandemic presents challenges and opportunities for healthcare, health promotion interventions, and overall improvement in healthcare seeking behaviour. This study explored the impact of COVID-19 on health knowledge, lifestyle, and healthcare seeking behaviour among residents of a resource-limited setting in Ghana.

METHODS

This qualitative study adopted an exploratory design to collect data from 20 adult residents in the Cape Coast Metropolis using face-to-face in-depth interviews. Data collected were analysed thematically and statements from participants presented verbatim to illustrate the themes realised.

RESULTS

Health knowledge has improved due to COVID-19 in terms of access to health information and increased understanding of health issues. There were reductions in risky health-related lifestyles (alcohol intake, sharing of personal items, and consumption of junk foods) while improvements were observed in healthy lifestyles such as regular physical exercise and increased consumption of fruits and vegetables. COVID-19 also positively impacted health seeking behaviour through increased health consciousness and regular check-ups. However, reduced healthcare utilization was prevalent.

CONCLUSION

The COVID-19 pandemic has presented a positive cue to action and helped improved health knowledge, lifestyle, and care seeking behaviour although existing health system constrains and low economic status reduced healthcare utilization. To improve health systems, health-related lifestyles and healthcare seeking behaviour as well as overall health outcomes even after the pandemic wades off, COVID-19 associated conscious and unconscious reforms should be systematically harnessed.

Spatial pattern of perinatal mortality and its determinants in Ethiopia: Data from Ethiopian Demographic and Health Survey 2016

BACKGROUND

The perinatal mortality rate in Ethiopia is among the highest in Sub Saharan Africa. The aim of this study was to identify the spatial patterns and determinants of perinatal mortality in the country using a national representative 2016 Ethiopia Demographic and Health Survey (EDHS) data.

METHODS

The analysis was completed utilizing data from 2016 Ethiopian Demographic and Health Survey. This data captured the information of 5 years preceding the survey period. A total of 7230 women who at delivered at seven or more months gestational age nested within 622 enumeration areas (EAs) were used. Statistical analysis was performed by using STATA version 14.1, by considering the hierarchical nature of the data. Multilevel logistic regression models were fitted to identify community and individual-level factors associated with perinatal mortality. ArcGIS version 10.1 was used for spatial analysis. Moran's, I statistics fitted to identify global autocorrelation and local autocorrelation was identified using SatSCan version 9.6.

RESULTS

The spatial distribution of perinatal mortality in Ethiopia revealed a clustering pattern. The global Moran's I value was 0.047 with p-value <0.001. Perinatal mortality was positively associated with the maternal age, being from rural residence, history of terminating a pregnancy, and place of delivery, while negatively associated with partners' educational level, higher wealth index, longer birth interval, female being head of household and the number of antenatal care (ANC) follow up.

CONCLUSIONS

In Ethiopia, the perinatal mortality is high and had spatial variations across the country. Strengthening partner's education, family planning for longer birth interval, ANC, and delivery services are essential to reduce perinatal mortality and achieve sustainable development goals in Ethiopia. Disparities in perinatal mortality rates should be addressed alongside efforts to address inequities in maternal and neonatal healthcare services all over the country.

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.

Pneumonia-related ideations, care-seeking, and treatment behaviors among children under 2 years with pneumonia symptoms in northwestern Nigeria

BACKGROUND

Prompt treatment of pediatric pneumonia symptoms is a cornerstone of child survival programs but remains a challenge in Nigeria. Psychosocial influences, or ideations, directly influence pathways to care but have not been previously measured or examined for pediatric pneumonia.

METHODS

A two-stage cluster-sample cross-sectional population-based survey was conducted in Kebbi, Sokoto, and Zamfara States in September 2019. Across 108 enumeration areas, all households were enumerated to census pregnant women and randomly sample women with children under 2 years ("under-twos") for inclusion. Respondents were asked about pediatric pneumonia and other health-related behaviors and ideations developed using the Ideation Model of Strategic Communication and Behavior Change. Prevalence ratios for predictors of care-seeking from formal medical sources and antibiotic treatment for pneumonia symptoms among under-twos were calculated using mixed-effects Poisson regression models with robust error variance.

RESULTS

Among 350 under-twos with pneumonia symptoms, 33.8% were taken to formal medical care and 38.0% used antibiotics. Women who positively viewed treatment efficacy and those who positively viewed health services quality had 1.35 (95% CI: 1.00-1.82; P = .050) and 2.13 (95% CI: 1.35-3.35; P = .001) times higher likelihood of attending formal medical sources, while women viewing peers as mostly attending drug shops had 29% lower likelihood. Perceived treatment efficacy and illness susceptibility were also significant predictors for antibiotic use.

CONCLUSIONS

Program interventions focusing on increasing pneumonia knowledge alone may not be sufficient to improve care-seeking and treatment rates and should expand to address perceived and actual poor-quality health services and maternal beliefs about treatment efficacy, social norms, illness severity, and susceptibility.

Mothers' Healthcare Autonomy, Maternal-Health Utilization and Healthcare for Children under-3 Years: Analysis of the Nigeria DHS Data (2008-2018)

This study was designed to simultaneously examine if mothers’ personal healthcare autonomy within the household, and the level of their maternal-healthcare utilization, translates into better preventive (complete immunization) and curative (treatments for diarrhoea, fever and acute respiratory infection) efforts on morbidities in child healthcare. We analysed data pooled from three consecutive waves of the Nigeria Demographic and Health Survey: the surveys of 2008, 2013 and 2018. Using a multilevel logistic regression, we estimated the odds ratio for each of the outcome variables while adjusting for covariates. Findings revealed that mothers’ health autonomy is positively associated with child immunization and treatment of morbidities (except diarrhoea), a relationship moderated by the frequency of mothers’ exposure to media. Additionally, mothers’ healthcare utilization is positively associated with complete immunization, and all forms of morbidity treatment (except diarrhoea). Although the relationship between mothers’ healthcare-utilization and child immunization is not dependent on family wealth, however, the relationship between mothers’ healthcare utilization and treatment of morbidity is dependent. Policy effort should be geared towards stimulating mothers to seek appropriate and timely child healthcare and future studies could consider looking into the mediating role of paternal support in this relationship.