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

Predictors of Mothers' Care Seeking Behavior for Common Childhood Illnesses: Findings From the Afghanistan Health Survey 2015

BACKGROUND

Mothers' care seeking behavior for childhood illness is a key factor of utilizing healthcare for children. We examined predictors of mothers' care seeking for common childhood illnesses.

METHODS

This was a cross-sectional study, using data from the Afghanistan Health Survey (AHS) 2015. Data were used from women who sought healthcare for their unwell children. The women were asked whether their children were sick with fever, cough, faster breathing, or diarrhea in the past 2 weeks. The outcome variable was defined as whether the mother sought healthcare for her unwell child from a public clinic, a private clinic, or from a pharmacy store. The Andersen's healthcare seeking behavior model was used and multinomial regression analysis applied.

RESULTS

There were 4979 women, aged 15-49 years, whose under-5 children were sick in the past 2 weeks. Thirty-nine percent of women sought healthcare for their children from a health provider. Mother's age, child's age, child's sex, socioeconomic status, mothers' perceived severity of childhood illness, and number of under-5 children were predictors of mothers' care seeking behavior. The likelihood of healthcare seeking was lower for older children (Adjusted odds ratio [OR] [95% CI]: 0.51 [0.37-0.70] from public clinics; 0.33 [0.23-0.47] from private clinics; 0.36 [0.22-0.61] from pharmacy stores), and for girls (Adjusted OR [95% CI]: 0.74 [0.59-0.93] from private clinics). The likelihood of healthcare seeking was greater for children whose mothers knew symptoms of childhood illness (Adjusted OR [95% CI]: 2.97 [1.44-6.16] from public clinics; 7.20 [3.04-17.04] from pharmacy stores). The likelihood of healthcare seeking for children was greater in older mothers (Adjusted OR [95% CI]: 1.54 [1.11-2.12]). It was less likely for the mothers who have more children to seek healthcare for their children (Adjusted OR [95% CI]: 0.53 [0.43-0.65] from public clinics; 0.61 [0.48- 0.79] from private clinics; 0.51 [0.37-0.69] from pharmacy stores).

CONCLUSION

Health policy-makers may opt to use our findings, particularly mothers' knowledge (perceived severity) of symptoms of childhood illness to develop interventions to enhance timely assessment and effective treatment of common preventable childhood illnesses.

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.

Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias

OBJECTIVE

This study explored provider perspectives on: (1) why inequalities in health service usage persist; and (2) their knowledge and understanding of the role of patient experience and implicit bias (also referred to as unconscious bias).

DESIGN

A three stage, iterative qualitative study was conducted involving two rounds of in-depth interviews and a training session with healthcare staff. Interview transcripts were analysed using a reflexive thematic approach in relation to the study's aims.

SETTING

Participants were recruited from rural hill districts (Mugu, Humla, Bajura, Gorkha and Sindhupalchok) of Nepal.

PARTICIPANTS

Clinical staff from 22 rural health posts.

RESULTS

Healthcare providers had high levels of understanding of the cultural, educational and socioeconomic factors behind inequalities in healthcare usage in their communities. However, there was less knowledge and understanding of the role of patient experience-and no recognition at all of the concept of implicit bias.

CONCLUSION

It is highly likely that implicit bias affects provider behaviours in Nepal, just as it does in other countries. However, there is currently not a culture of thinking about the patient experience and how that might impact on future usage of health services. Implicit bias training for health students and workers would help create greater awareness of unintended discriminatory behaviours. This in turn may play a part in improving patient experience and future healthcare usage, particularly among disadvantaged groups.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Determinants affecting utilisation of health services and treatment for children under-5 in rural Nepali health centres: a cross-sectional study

Background

Large inequalities in child health remain in Nepal, with caste, ethnicity and sex being major determinants of deprivation and negative outcomes. The purpose of this study was to explore whether key demographics of under 5s were associated with health seeking behaviours, utilisation of health care, and treatment received.

Methods

Data came from Integrated Management of Neonatal & Childhood Illness (IMNCI) records of 23 health centres across five districts. After digitising the paper records, the data was analysed by district, caste/ethnicity, sex, and age to investigate differences in the time taken to present at a health facility after the onset of symptoms of ARI, diarrhoea and fever; accuracy of diagnosis for pneumonia; and whether the correct treatment was prescribed for pneumonia as per IMNCI guidelines.

Results

From 116 register books spanning 23 health centres, 30,730 child patient records were considered for analysis. The median age of attendance was 18 months (Inter-Quartile Range = 10, 32), while were more male children that attended (55.7% vs. 44.3% for females). There were statistically significant differences for the time taken to attend a health centre between different districts for ARI, diarrhoea and fever, with children in the remote Humla and Mugu districts taking significantly longer to present at a health facility after the onset of symptoms (all p < 0.001, except Mugu for ARI days). Children from underprivileged ethnic groups, Madhesi and Dalit, were less likely to be given a correct diagnosis of pneumonia (p = 0.014), while males were more likely to receive a correct diagnosis than females (73% vs. 67%, p = 0.001). This sex difference remained in the adjusted regression models for diagnosis of pneumonia (p < 0.001) but not for treatment of pneumonia (p = 0.628). All districts, in comparison to Gorkha, had increased odds of correct diagnosis and treatment of pneumonia, but only significant in children from Mugu after adjustment (p ≤ 0.001).

Conclusion

Significant demographic differences were found based on ethnicity, sex, and district when examining health seeking behaviours for ARI, diarrhoea, and fever. Significant associations were seen for these same factors when exploring accuracy of diagnoses of pneumonia, but not for treatment. This study has emphasised the importance of a digitalised healthcare system, where inequalities can be identified without the reliance on anecdotal evidence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14318-y.

Factors influencing health service utilization among mothers for under-five children: A cross-sectional study in Khulna district of Bangladesh

Although Bangladesh has made significant progress in reducing child mortality, proper utilization of health services for under-five children among mothers remains one of the major challenges. Hence, this study was designed to investigate the factors influencing health service utilization among mothers for under-five children in the Khulna district of Bangladesh. Administering a semi-structured interview schedule, data were collected from 364 randomly selected mothers from the study area between June and August 2021. At first, Pearson’s Chi-square test was conducted to measure the association between outcome and predictor variables. Multivariable logistic regression model was used to identify the factors associated with utilization of health services. Overall, about 59 percent of the mother received health services from unqualified doctors during their children’s illness and the rest of them (41.5%) seek care from the qualified doctors. Results of regression analysis revealed that long duration of illness (AOR = 2.338; CI: 1.175–4.649; p = 0.015), the severity of illness (AOR = 6.402; CI: 3.275–12.513; p<0.001), and higher cost of treatment (AOR = 7.371; CI: 3.297–16.480; p<0.001) were the significant predictors of utilization of health services from the qualified doctors for under-five children. Thus, the study suggests that to reduce under-five child mortality by ensuring proper utilization of health services, it is necessary to raise awareness among mothers, improve transport facilities, establish need-based health care centers, and lower treatment costs.

Integrated Community Case Management Utilization Status and Associated Factors Among Caretakers of Sick Children Under the Age of 5 Years in West Shewa, Ethiopia

Objective

To assess the utilization status and associated factors of integrated community case management (ICCM) of caretakers with <5 years of sick children.

Methods

Community-based cross-sectional study was employed with caretakers whose child was sick in the last 3 months before data collection. Bivariate and multivariable logistic regression analyses were employed.

Results

About 624 respondents participated in the study; 325 (52.1%) utilized integrated community case management. Caring for children between the ages 24–36 months old, (AOR = 1.26, 95%CI: 0.23, 0.90); women health development army (WHDA) training, (AOR = 5.76, 95%CI: 3.57, 9.30); certified as model family, (AOR = 3.98, 95%CI: 2.45, 6.46); perceived severity, (AOR = 5.29, 95%CI: 2.64, 10.60); awareness of danger sign, (AOR = 2.76, 95%CI: 1.69, 4.50), and awareness of ICCM, (AOR = 5.42, 95%CI: 1.67, 17.58) were associated with ICCM utilization.

Conclusion

This study revealed that age of the child, caretakers' awareness of ICCM, awareness of danger signs, illness severity, women's health developmental army training, and graduation as a model family were associated with ICCM utilization. Therefore, it is recommended that promote health education using community-level intervention modalities focusing on common childhood illness symptoms, danger signs, severity, and care-seeking behavior.

Factors associated with delay in treatment-seeking behaviour for fever cases among caregivers of under-five children in India: Evidence from the National Family Health Survey-4, 2015-16

BACKGROUND

Fever is one of the common clinical symptoms found among children suffering from various illnesses. India carries a substantial burden of febrile illness among under-five children which heighten the risk of malnutrition, mortality and morbidity. This study aims to determine the factors associated with delay in treatment-seeking for fever among under-five children in India.

METHODS

A cross-sectional study was carried out using the large-scale nationally representative data from the National Family Health Survey (NFHS-4), conducted in 2015-2016. The data were collected by using four survey questionnaires i.e., Household Questionnaire, Woman's Questionnaire, Man's Questionnaire, and Biomarker Questionnaire. Delay in treatment-seeking was defined as taking a child for treatment after 24 hours of fever onset. Bivariate and multivariate logistic regression models were performed to assess the factors associated with delay in treatment-seeking behaviour for fever in under-five children.

RESULTS

In India, 31.12% (n = 7229) of the caregivers sought treatment for children after 24 hours of the onset of fever. Findings show no significant differences in delay in treatment-seeking behaviour by age groups and sex of children. Multivariate analysis revealed that the odds of delay in treatment-seeking behaviour of fever were higher among children from the poorest wealth quintile (AOR: 2.06; 95% CI: 1.85, 2.31), belonging to the scheduled tribe (AOR: 1.35; 95% CI: 1.24, 1.48), children who resided in rural areas (AOR: 1.14; 95% CI: 1.07, 1.22), children from the northeast region (AOR: 1.29; 95% CI: 1.14, 1.46), and children of caregivers who perceived distance to health facilities as a 'big problem' (AOR: 1.16; 95% CI: 1.09, 1.23).

CONCLUSION

The study shows a high prevalence of delay in seeking treatment for fever among caregivers of under-five children in India. Delay in seeking treatment is associated with socio-demographic and socio-economic factors. Therefore, there is a need for intensified health promotion programs to sensitize caregivers on the importance of early health-seeking behaviour.

Understanding the context of healthcare utilisation for children under-five with diarrhoea in the DRC: based on Andersen behavioural model

BACKGROUND

Diarrhoea is one of the leading causes of death among children under 5 years old in the Democratic Republic of the Congo (DRC). Despite positive effects on prognosis, there is limited literature about the healthcare-seeking behaviours of children with diarrhoea, especially in the DRC. This study used the Andersen Behavioural Model, a theoretical framework, which was commonly adopted to study healthcare utilisation, to investigate and predict factors associated with the use of healthcare to treat diarrhoea in the DRC.

METHODS

Data collected from 2626 under-five children with diarrhoea in the last 2 weeks from the Multiple Indicators Cluster Survey conducted by the National Institute of Statistics in 2017-2018, in collaboration with the United Nations Children's Fund were used in this study. Both direct and indirect relationships among four latent variables: predisposing traits, enabling resources access, health needs, and health services use were measured using the structural equation modelling to test the Andersen behavioural model. The confirmatory Factor Analysis model was also modified based on the DRC context to explore this further.

RESULTS

The modified model had the goodness of fit index (GFI) of 0.972, comparative fit index (CFI) of 0.953 and RMSEA of 0.043 (95% CI: 0. 040, 0.047). Health needs (especially diarrhoea) had the largest positive direct effect on healthcare utilisation (standardized regression coefficient [β] = 0.135, P < 0.001), followed by "enabling resources" (β = 0.051, P = 0.015). Health needs also emerged as a mediator for the positive effect of predisposing on utilisation (indirect effect, β = 0.014; P = 0.009).

CONCLUSION

Access to improved water and improved sanitation, as well as socioeconomic factors like household wealth, were significantly associated with health-seeking behaviours for diarrhoea treatment in the DRC. Besides, caregivers who own higher levels of educational attainments were more inclined to have positive health services uses during the treatments. Efforts are needed to enhance the oral rehydration therapy coupled with educating caregivers on its appropriate use.

Inequity in health care utilization for common childhood illnesses in India: measurement and decomposition analysis using the India demographic and health survey 2015-16

BACKGROUND

Though child mortality has dropped remarkably, it is considerably high in South Asia. Across the globe, 5.2 million children under 5 years of age died in 2019, and India accounts for a significant portion of these deaths. Common childhood illnesses are the leading cause of these deaths. Seeking care from formal providers can reduce these avoidable deaths. Inequity is a crucial blockage in optimum utilization of medical treatment for children. Hence, the present study analyzes the inequalities and horizontal inequities in utilizing the medical treatment for diarrhea, fever, acute respiratory infection (ARI), and any of these common childhood illnesses in India and across the Indian states. The study also attempts to locate significant contributors to these inequalities.

METHODS

The study used 0 to 59 months children's data sourced from the Demographic and Health Survey, India (2015-16). Concentration Index (CI) and Erreygers Corrected Concentration Index (EI) were used to measure the inequalities. The Horizontal Inequity Index (HII) was deployed to estimate inequity. The decomposition method introduced by Erreygers was applied to determine the significant contributors of inequalities.

RESULTS

The EI in medical treatment-seeking for common childhood illnesses was 0.16, while the HII was 0.15. The highest inequality was perceived in the utilization of medical treatment for ARI (0.17). The primary contributing factors of these inequalities were continuum of maternal care (18.7%), media exposure (12%), affordability (9.3%), place of residence (9.1%), mother's education (8.5%), and state groups (8.8%). The North-Eastern states showed the highest level of inequality across the Indian states.

CONCLUSION

The study reveals that the horizontal inequity in medical treatment utilization for children in India is pro-rich. The findings of the study suggest that attuning the efforts of existing maternal and child health programs into one seamless chain of care can bring the inequalities down and improve the utilization of child health care services. The spread of health education through different media sources, reaching out to rural and remote places with adequate health personnel, and easing out the financial hardship in accessing medical treatment could be the cornerstone in accelerating the utilization level amongst the impoverished children.

Healthcare utilisation: a mixed-method study among tea garden workers in Indian context

Purpose

The study examined the utilisation patterns of healthcare services among tea garden workers and analysed the factors influencing utilisation in an Indian context.

Design/methodology/approach

The authors employed a mixed-method approach and an explanatory sequential design for the study. A survey was conducted in the beginning followed by in-depth interviews in a north-eastern state of India (Assam). Andersen health behaviour model was used to explore the factors influencing healthcare utilisation. The sample size for the survey and in-depth interviews were 300 and 19, respectively, recruited employing multistage random and purposive sampling techniques.

Findings

Out of 300 workers surveyed, 169 (56.3%) were females, 257 (85.7%) were married, 77 (25.7%) were illiterates and 229 (76.3%) had monthly household income less than 100 US$. The survey also found that 47.3% and 15.3% had non-communicable and communicable disease respectively. Most of the workers (67.3%) utilised government facilities, and close to one third (28.7%) utilised tea garden hospitals. About 63.3% had health insurance, but a majority (78.9%) did not use it previously. The analyses of interviews explored the need, enabling, predisposing factors under three important themes influencing utilisation of healthcare services among the workers.

Practical implications

The study generates evidence to strengthen the Indian Plantation Labour Act, 1951 for tea garden worker's welfare protection and warrants transition from colonial-era policies to contemporary industry realities in order to improve their living, employment, nutritional and health conditions.

Originality/value

The research adds to the existing literature on overall healthcare services utilisation (including coverage and utilisation of health insurance) among blue collar workers who usually lack access to healthcare facilities and explores important factors that determine utilisation in the Indian context.

Private health care market shaping and changes in inequities in childhood diarrhoea treatment coverage: evidence from the analysis of baseline and endline surveys of an ORS and zinc scale-up program in Nigeria

BACKGROUND

Nearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. In this study, we examine changes in the inequities of coverage of ORS and zinc over the intervention period.

METHODS

Baseline and endline household surveys were used to measure ORS and zinc coverage and household assets. Principal component analysis was used to construct wealth quintiles. We used multi-level logistic regression models to estimate predictive coverage of ORS and zinc by wealth and urbanicity at each survey period. Simple measures of disparity and concentration indices and curves were used to evaluate changes in ORS and zinc coverage inequities.

RESULTS

At baseline, 28% (95% CI: 22-35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52-58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P <  0.001) for the poorest and 17%-points (P <  0.001) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration indices declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35-41%) compared to 29% (95%CI, 25-33%) in the urban.

CONCLUSION

The results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.

Receipt of Weekly Iron Supplementation among Indian Children, 2005-2016

BACKGROUND

In response to India's unacceptably high burden of anemia among children aged 6-59 mo, the central government introduced the National Iron Plus Initiative program which recommends an intervention of iron supplementation to mitigate anemia, especially iron deficiency anemia.

OBJECTIVE

The objective of this study was to examine the trend (between 2005-2006 and 2015-2016) in receiving weekly iron supplementation (WIS) among children aged 6-59 mo, and factors associated with receiving WIS during 2015-2016.

METHODS

Two waves of the nationally representative cross-sectional National Family Health Survey (NFHS) data collected during 2005-2006 (NFHS-3) and 2015-2016 (NFHS-4) were used. The trend was measured using both rounds of datasets, whereas factors associated with WIS receipt were assessed from NFHS-4. The trend was assessed using a sample of 35,650 children from NFHS-3 and 202,227 children from NFHS-4. After exclusion of 8978 cases, a total of 199,110 children were included to analyze the factors associated with receiving WIS. Using appropriate sample weighting, unadjusted and adjusted (multivariate) logistic regression analyses were deployed. Application of the chi-squared test and checking for multicollinearity were also part of the analysis. The possibility of sample selection bias was tested.

RESULTS

An increase of WIS receipt (from 4.6% in 2005-2006 to 26% in 2015-2016) was observed. Older children, children living in rural areas, children belonging to Scheduled Tribes, children of mothers with secondary education or higher, and children whose mothers had some mass media exposure had higher odds of receiving WIS. Children of fifth or higher birth order, children who were followers of Islam and Christianity, children from the richest economic group, noninstitutional birth of children, and children from high-focus group states were negatively associated with WIS receipt.

CONCLUSIONS

Despite improvement (between 2005-2006 and 2015-2016) in receiving WIS, coverage remains unacceptably low (in absolute terms). The suboptimum performance of WIS intervention demands further investigation.

Factors impacting time to diagnosis in pediatric CNS tumors in Chinese children

OBJECTIVE

This study aimed to investigate the factors impacting time to diagnosis in pediatric central nervous system tumors.

METHODS

A descriptive, cross-sectional design was used in this study. A self-developed questionnaire for health-seeking behavior and influencing factors was used in children with intracranial tumors. The factors related to time to diagnosis and the long-term prognosis of children were analyzed.

RESULTS

A total of 433 families replied to the questionnaire. The median parental interval was 50 days (range 0 ~ 884), the median diagnostic interval was 97 days (range 4 ~ 1646), and the median prediagnostic symptomatic interval (PSI) was 123 days (range 8 ~ 1844). Higher education was associated with a shorter parental interval (mother: P = 0.048; father: P = 0.035). The diagnostic interval was shortened in patients with dizziness (P = 0.022), abnormal eye movement (P = 0.034), or drowsiness (P = 0.021). A shorter PSI was observed in patients who presented with high intracranial pressure such as headache (P = 0.016), dizziness (P = 0.009), or drowsiness (P = 0.023) and those who went to a higher-level health institution or patients who went to neurology or neurosurgery department as the first medical consultation. No statistically significant difference was found in the interval time (parental interval, diagnostic interval, and PSI) regarding patients' outcomes.

CONCLUSION

Different time intervals showed different factors influencing the long delay in diagnosing central nervous system tumors, highlighting the need for increased awareness to improve the treatment efficacy.

Sex differences in child health and healthcare: A reappraisal for India

India has an unenviable reputation as one of the world's most gender disparate countries. Previous studies of sex bias in childhood have shown large differences between Indian boys and girls in immunization and curative healthcare, but little difference in health status as indicated by anaemia and stunting. India has changed rapidly in past decades, hence we reappraise the situation with the National Family Health Survey-4 (2015-16). We found no evidence of sex differentials in immunization coverage but a small degree of discrimination in favour of boys in medical treatment for common symptoms of infection. This discrimination was no greater in the North and Central regions of India, where severe excess mortality among female children persists. Sex differences in anaemia and stunting were small, with no regional pattern. We found no evidence that healthcare or health status of girls was influenced by the presence of other daughters in the family.

Health Care–Seeking Behavior of Children With Acute Respiratory Infections Symptoms: Analysis of the 2012 and 2017 Indonesia Demographic and Health Surveys

Our study examined factors associated with the utilization of health services in children younger than 5 years with acute respiratory infections (ARIs) symptoms in Indonesia. Data were derived from the 2012 and 2017 Indonesia Demographic and Health Survey. Information from 1408 children younger than 5 years showing ARI symptoms in the past 2 weeks before the survey was analyzed using logistic regression analyses. Around 25% of children younger than 5 years with ARI symptoms did not receive medical care. The odds of receiving care increased in mothers from rich households. The odds reduced in children aged 2 or more years; children of mothers not assisted by trained delivery attendants; mothers attending none or <4 antenatal visits; mothers delivering at home, and mothers reporting that permission to visit health services was a problem. Efforts to improve care-seeking behavior are required. Health promotion strategies and interventions to improve access to reach community not regularly exposed to health services are important.

Determinants and patterns of care-seeking for childhood illness in rural Pune District, India

BACKGROUND

An estimated 1.2 million children under five years of age die each year in India, with pneumonia and diarrhea among the leading causes. Increasing care-seeking is important to reduce mortality and morbidity from these causes. This paper explores the determinants and patterns of care-seeking for childhood illness in rural Pune district, India.

METHODS

Mothers having at least one child <5 years from the study area of the Vadu Health and Demographic Surveillance System were enrolled in a prospective cohort study. Household sociodemographic information was collected through a baseline questionnaire administered at enrollment. Participants were visited up to six times between July 2015 and February 2016 to collect information on recent childhood acute illness and associated care-seeking behavior. Multivariate logistic regression explored the associations between care-seeking and child, participant, and household characteristics.

RESULTS

We enrolled 743 mothers with 1066 eligible children, completing 2585 follow-up interviews (90% completion). Overall acute illness prevalence in children was 26% with care sought from a health facility during 71% of episodes. Multivariable logistic regression showed care-seeking was associated with the number of reported symptoms (Odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.5-3.9) and household insurance coverage (OR = 2.2, 95% CI = 1.1-4.3). We observed an interaction between the associations of illness severity and maternal employment on care-seeking. Somewhat-to-very severe illness was associated with increased care-seeking among both employed (OR = 5.0, 95% CI = 2.2-11.1) and currently unemployed mothers (OR = 7.0, 95% CI = 3.9-12.6). Maternal employment was associated with reduced care-seeking for non-severe illness (OR = 0.3, 95% CI = 0.1-0.7), but not associated with care-seeking for somewhat-to-very severe illness. Child sex was not associated with care-seeking.

CONCLUSIONS

This study demonstrates the importance of illness characteristics in determining facility-based care-seeking while also suggesting that maternal employment resulted in decreased care-seeking among non-severe illness episodes. The nature of the association between maternal employment and care-seeking is unclear and should be explored through additional studies. Similarly, the absence of male bias in care-seeking should be examined to assess for potential bias at other stages in the management of childhood illness.

Inequalities in health care utilization for common illnesses among under five children in Bangladesh

Background

Reducing child mortality and morbidity is a public health concern globally. Like many other developing countries, Bangladesh is struggling to improve child health status as the use of medical treatment is still not at a satisfactory level. Hence, the objective of this study is to identify the contributing factors for inequalities in the use of medical treatment for common childhood illnesses in Bangladesh.

Methods

The study used data from the latest Bangladesh Demographic and Health Survey (BDHS)-2014. Children who had diarrhea, fever and cough in the 2 weeks preceding the survey were included in this study. Bivariate and multivariate analyses were conducted to unearth the influential factors for medical treatment use among under-five children with childhood illnesses. In the multivariate logistic regression, adjusted odds ratios with p values less than 0.05 were considered for determining significant predictors.

Results

This study found that only 37% of children suffering from fever/cough sought medical treatment while this figure was approximately 36% for diarrhea. Age of children, household wealth status, father’s education level, region of residence, number of children in the household, access to electronic media were identified as factors contributing to inequality in health care utilization for common childhood illnesses in Bangladesh.

Conclusions

Various socio-economic factors substantially influence the utilization of medical treatment for childhood illnesses. Therefore, to enhance equitable access to health care for children, interventions should be designed targeting children from households with low socio-economic status. Various awareness-raising health education programs, poverty alleviation programs especially for rural areas can contribute in this regard.

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.

Factors Influencing Residents' Willingness to Contract With General Practitioners in Guangzhou, China, During the GP Policy Trial Phase: A Cross-Sectional Study Based on Andersen's Behavioral Model of Health Services Use

This study aimed to investigate the current contract rate and residents’ willingness to contract with general practitioner (GP) services in Guangzhou, China, during the policy trial phase, and also to explore the association of behavior contract and contract willingness with variables based on Andersen’s Behavioral Model of Health Services Use (ABM). In total, 160 residents from community health centers (CHCs) and 202 residents from hospitals were recruited in this study. The outcome variables were behavior contract and contract willingness. Based on the framework of ABM, independent variables were categorized as predisposing factors, enabling factors, need factors, and CHC service utilization experiences. Univariate and multivariate logistic regression analysis models were applied to explore the associated factors. Out of 362 participants, 14.4% had contracted with GP services. For those who had not contracted with GP services, only 16.4% (51 out of 310) claimed they were willing to do so. The contract rate for community-based participants was significantly higher than that for hospital-based participants. Major reasons for not choosing to contract were perceiving no benefit from the service and concerns about the quality of CHCs. Community health center experiences and satisfaction were significantly associated with contracting among hospital-based participants. A need factor (diagnosed with hypertension or diabetes) and CHC service utilization experiences (have gotten services from the same doctor in CHCs) were significantly associated with contract willingness among CHC-based participants. Intervention to improve awareness of GP services may help to promote this service. Different intervention strategies should be used for varying resident populations.

Parents' healthcare-seeking behavior for their children among the climate-related displaced population of rural Bangladesh

In Bangladesh climate change has contributed to a massive displacement of people. This study examines the effects of climate-related displacement, socioeconomic status, availability of healthcare providers and disease-related attributes on the healthcare-seeking behaviors of parents for their children. Using cross-sectional survey data from the parents of 1003 children aged under 15 who were ill in the four weeks prior to the interview, collected from 600 randomly-selected households in climate displacement-susceptible areas and 600 households in non-climate-displacement-susceptible areas in Bangladesh, we use multivariate logistic regression to identify the factors associated with parental healthcare-seeking behaviors. The results show that 15.5% of the children who had been ill receive either no care or curative care at home. Of those receiving care outside the home, only 22.1% are treated by trained providers. Climate-related displaced parents are significantly less likely to seek care or to use provider-prescribed care to manage children's illnesses. Areas lacking local healthcare providers, poorer households, females, child age and mild illness are also associated with a child being significantly less likely to be treated outside the home. The children of climate-related displaced parents are around half as likely as those of non-displaced parents to be treated by a trained provider. The local availability of medical doctors, cost of reaching a healthcare center, household income, type and severity of illness, child's age, and joint parental decision-making about care providers are also important predictors of the selection of trained healthcare providers for children. Thus, climate-related displacement affects the healthcare-seeking behaviors of parents for their children. Policy aimed at improving child health should address the socioeconomic disadvantage and access to healthcare of the displaced, the training of local untrained providers about Primary Health Care service provision, and the numbers of medical doctors in the displacement-prone areas.

Risk of postneonatal mortality, hospitalisation and suboptimal breast feeding practices in low birthweight infants from rural Haryana, India: findings from a secondary data analysis

OBJECTIVES

Low birth weight (LBW) is a risk factor for neonatal mortality and morbidity. It is important to examine whether this risk persists beyond neonatal period. The current secondary data analysis aimed to examine association of birth weight with mortality, hospitalisation and breast feeding practices during infancy.

DESIGN

Data from a large randomised controlled trial of neonatal vitamin A supplementation (Neovita) trial were used. Log binomial model was applied to assess association between birth weight and mortality, hospitalisation and breast feeding practices.

SETTING

Rural Haryana, North India.

PARTICIPANTS

Newborns recruited in the primary intervention trial that aimed to evaluate the effect of single-dose oral vitamin A supplementation on mortality in the first 6 months of life.

RESULTS

We recruited a total of 44 984 infants, of which 10 658 (23.7%) were born LBW, that is, birth weight less than 2500 g. In the neonatal period, LBW babies had four times higher risk of mortality (relative risk (RR) 3.92; 95% CI 3.33 to 4.66) compared with normal birthweight babies. In the postneonatal period, the risk was two times higher (RR 1.92; 95% CI 1.71 to 2.15); even higher in those with birth weight <2000 g (RR 3.38; 95% CI 2.71 to 4.12). The risk of hospitalisation in the neonatal period and postneonatal period was (RR 1.86; 95% CI 1.64 to 2.11) and (RR 1.13; 95% CI 1.05 to 1.21), respectively. LBWs were at increased risk of breast feeding initiation 24 hours after birth (RR 1.64; 95% CI 1.45 to 1.81), no breast feeding at 6 months (RR 1.34; 95% CI 1.23 to 1.46) and at 12 months of age (RR 1.24; 95% CI 1.18 to 1.30).

CONCLUSIONS

LBW babies, especially those with birth weight of <2000 g, were at increased risk of mortality, hospitalisation and suboptimal breast feeding practices during entire infancy and therefore require additional care beyond the first 28 days of life.

TRIAL REGISTRATION NUMBER

NCT01138449.

Potential impact of introducing the pneumococcal conjugate vaccine into national immunisation programmes: an economic-epidemiological analysis using data from India

Pneumococcal pneumonia causes an estimated 105 000 child deaths in India annually. The planned introduction of the serotype-based pneumococcal conjugate vaccine (PCV) is expected to avert child deaths, but the high cost of PCV relative to current vaccines provided under the Universal Immunization Programme has been a concern. Cost-effectiveness studies from high-income countries are not readily comparable because of differences in the distribution of prevalent serotypes, population and health systems. We extended IndiaSim, our agent-based simulation model representative of the Indian population and health system, to model the dynamics of Streptococcus pneumoniae. This enabled us to evaluate serotype and overall disease dynamics in the context of the local population and health system, an aspect that is missing in prospective evaluations of the vaccine. We estimate that PCV13 introduction would cost approximately US$240 million and avert US$48.7 million in out-of-pocket expenditures and 34 800 (95% CI 29 600 to 40 800) deaths annually assuming coverage levels and distribution similar to DPT (diphtheria, pertussis and tetanus) vaccination (~77%). Introducing the vaccine protects the population, especially the poorest wealth quintile, from potentially catastrophic expenditure. The net-present value of predicted money-metric value of insurance for 20 years of vaccination is US$160 000 (95% CI US$151 000 to US$168 000) per 100 000 under-fives, and almost half of this protection is for the bottom wealth quintile (US$78 000; 95% CI 70 800 to 84 400). Extending vaccination to 90% coverage averts additional lives and provides additional financial risk protection. Our estimates are sensitive to immunity parameters in our model; however, our assumptions are conservative, and if willingness to pay per years of life lost averted is US$228 or greater, then introducing the vaccine is more cost-effective than our baseline (no vaccination) in more than 95% of simulations.

Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda

Background

Over half of under-five deaths occur in sub-Saharan Africa and appropriate, timely, quality care is critical for saving children’s lives. This study describes the context surrounding children’s deaths from the time the illness was first noticed, through the care-seeking patterns leading up to the child’s death, and identifies factors associated with care-seeking for these children in rural Rwanda.

Methods

Secondary analysis of a verbal and social autopsy study of caregivers who reported the death of a child between March 2013 to February 2014 that occurred after discharge from the child’s birth facility in southern Kayonza and Kirehe districts in Rwanda. Bivariate analyses using Fisher’s exact tests were conducted to identify child, caregiver, and household factors associated with care-seeking from the formal health system (i.e., community health worker or health facility). Factors significant at α = 0.10 significance level were considered for backwards stepwise multivariate logistic regression, stopping when remaining factors were significantly associated with care-seeking at α = 0.05 significance level.

Results

Among the 516 eligible deaths among children under-five, 22.7% (n = 117) did not seek care from the health system. For those who did, the most common first point of contact was community health workers (45.8%). In multivariate logistic regression, higher maternal education (OR = 3.36, 95% CI: 1.89, 5.98), having diarrhea (OR = 4.21, 95%CI: 1.95, 9.07) or fever (OR = 2.03, 95%CI: 1.11, 3.72), full household insurance coverage (3.48, 95%CI: 1.79, 6.76), and longer duration of illness (OR = 22.19, 95%CI: 8.88, 55.48) were significantly associated with formal care-seeking.

Conclusion

Interventions such as community health workers and insurance promote access to care, however a gap remains as many children had no contact with the health system prior to death and those who sought formal care still died. Further efforts are needed to respond to urgent cases in communities and further understand remaining barriers to accessing appropriate, quality care.

WOMEN'S EDUCATION AND UTILIZATION OF MATERNAL HEALTH SERVICES IN AFRICA: A MULTI-COUNTRY AND SOCIOECONOMIC STATUS ANALYSIS

There is an abundant literature on the relationship between women's education and maternal and child outcomes, including antenatal and postnatal care, onset of antenatal care and skilled birth attendance. However, few studies have adopted the 'equity' lens, despite increasing evidence that inequities between rich and poor are increasing although maternal and child mortality is declining. This study examined the differential effects of women's education within different socioeconomic strata in Africa. The most recent Demographic and Health Surveys (DHS) conducted in the Democratic Republic of the Congo, Egypt, Ghana, Nigeria and Zimbabwe were used. In each country, the original sample was stratified into three socioeconomic groups: poor, middle and rich. For each maternal health service utilization variable, the gross and net effects of women's education, controlling for age, parity, religion, marital status, health insurance, access to health facilities, partner's education and current place of residence, were estimated using logistic regression, taking into account the complex sampling design of the DHS. The findings revealed country-specific variations in maternal health service utilization, and for most indicators there was a clear gradient among socioeconomic strata: women living in better-off households exhibited greater access to, and utilization of, maternal health services. Multivariate analyses revealed that women's education had a positive association with type of antenatal care provider, timing and frequency of antenatal care visits, place of delivery and presence of a skilled birth attendant at delivery. Many other factors were found to be significantly associated with maternal health service utilization. For instance, parity had a negative and significant association with timing of first antenatal care visit. Likewise, partner's education was positively and statistically associated with timing of first antenatal care visit. It is argued that an over-generalization of the association between women's education and maternal health service utilization can be misleading. Efforts to improve maternal health service utilization in Africa must adopt an 'equity' approach, taking into account the specific needs of sub-populations.

Treatment-seeking and out-of-pocket expenditure on childhood illness in a migrant tribal community in Bhubaneswar, Odisha State, India

BACKGROUND

In India, migrant status, tribal affiliation and poverty render tribal migrants more vulnerable than any other group which leads to high treatment costs and the risk of low access to health care.

OBJECTIVE

To examine treatment-seeking behaviour and out-of-pocket (OOP) expenditure on the treatment of childhood illnesses, with a focus on gender in a migrant tribal community in Bhubaneswar, eastern India.

METHODS

A total of 175 households with a child aged 0-14 years and who had migrated within the last 12 years were selected from tribal-dominated slums. Data on health-seeking behaviour and expenditure on a recent illness in the youngest child were collected by interviewing mothers during October 2007 to March 2008.

RESULTS

Of the 175 children, 78.8% had at least one episode of illness during the previous year. Of the total number of episodes, 71% had been treated and 61% of them had incurred OOP expenditure. A significantly lower proportion of episodes of illness in girls had been treated than in boys (P = 0.01) and incurred OOP expenditure (P = 0.05). Private health care was preferred and only 16.5% availed themselves of the government sources. About 89 and 87% of households of boys and girls, respectively, incurred OOP expenditure. A child's gender (female) (P = 0.05), mother's education (P = 0.002) and type of illness (P = 0.002) were significantly associated with total OOP expenditure.

CONCLUSION

Further studies are warranted to address the low access to government health care and thereby reduce high OOP expenditure by tribal migrants on low incomes. Efforts are required to increase the ability of communities and health providers to identify and address the issues of gender and equity in health care along with a focus on culture-sensitive service provision.

Cost-effectiveness analysis of the diarrhea alleviation through zinc and oral rehydration therapy (DAZT) program in rural Gujarat India: an application of the net-benefit regression framework

BACKGROUND

This study evaluates the cost-effectiveness of the DAZT program for scaling up treatment of acute child diarrhea in Gujarat India using a net-benefit regression framework.

METHODS

Costs were calculated from societal and caregivers' perspectives and effectiveness was assessed in terms of coverage of zinc and both zinc and Oral Rehydration Salt. Regression models were tested in simple linear regression, with a specified set of covariates, and with a specified set of covariates and interaction terms using linear regression with endogenous treatment effects was used as the reference case.

RESULTS

The DAZT program was cost-effective with over 95% certainty above $5.50 and $7.50 per appropriately treated child in the unadjusted and adjusted models respectively, with specifications including interaction terms being cost-effective with 85-97% certainty.

DISCUSSION

Findings from this study should be combined with other evidence when considering decisions to scale up programs such as the DAZT program to promote the use of ORS and zinc to treat child diarrhea.

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.

Utilization of health facilities and predictors of health-seeking behavior for under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia: a community-based cross-sectional study

BACKGROUND

Information on health-seeking behavior and utilization of health facilities in slums of Addis Ababa is scarce, impeding the implementation of effective interventions. The purpose of this study is to assess the status of health facilities utilization and predictors for health-seeking behavior of mothers/caregivers of under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia.

METHODS

A community-based cross-sectional study design was employed in five rounds of surveys in seven kebeles in slums of Addis Ababa among 472 mothers/caregivers of 472 under-five children with acute diarrhea in reference to Andersen's behavioral model. Data were entered into EpiData Version 3.1 and analyzed using STATA Version 14.0. Descriptive statistics were used to examine patterns of health facilities utilization and multivariable logistic regression analysis was applied to identify predictors associated with health-seeking behavior.

RESULTS

Most mothers/caregivers (70.8%) sought care either at home (14.2%) or health facilities (56.6%), whereas 29.2% reported that they did not seek any care. Of those who consulted health facilities, government health facilities (76.9%) were more utilized than private (18.0%) and informal (5.1%) health facilities. Nearly all (93.9%) of the mothers/caregivers using government health facilities used health centers, and of those who took their children to private health facilities (60.9%) used clinics and 26.1% used pharmacies/drug vendors. Mothers/caregivers visiting health facilities obtained mainly oral rehydration salt (ORS) (39.8%) and home-recommended fluids (HRF) (40.3%), but few of them (11.9%) obtained ORS plus zinc supplementation. Predisposing factors of literacy of mothers/caregivers (adjusted odds ratio (AOR) = 2.4; 95% CI 1.4-4.1) and occupation (AOR = 2.6; 95% CI 1.5-4.6), the enabling factors of households monthly income of 50 United States Dollars (US$) and above (AOR = 2.9; 95% CI 1.5-5.6) and availability of nearest health facilities within 15 min walking distance (AOR = 3.3; 95% CI 1.7-6.6), and the need factors of recognizing danger signs of fever (AOR = 4.3; 95% CI 2.4-7.6) and vomiting (AOR = 3.3; 95% CI 1.8-5.9) were significantly associated with health-seeking behavior.

CONCLUSIONS

Increasing the proximity of health facilities in slums and health education and socioeconomic development programs targeting illiterate mothers/caregivers and poor households may promote and increase health-seeking behavior and the accessibility of health facilities for the treatment of acute diarrhea in under-five children in Addis Ababa slums.

Interrupting pathways to sepsis: Effectiveness of an intervention to reduce delays in timely care for sick children in rural Bangladesh

RATIONALE

The time it takes for a child with suspected sepsis to receive care is critical.

OBJECTIVE

We evaluated care-seeking practices for sick children under 5 years in rural Bangladesh, following interpersonal communication to inform households of newly introduced supports for quality care. Based on the Delays Framework, we assessed length and source of care-seeking delays, use of formal providers, and autonomous decision-making among mothers.

METHOD

Using two cross-sectional rounds before and after the 3-year intervention (August 2012 and August 2015), we surveyed 400 mothers of recently sick children in 26 randomly sampled villages from 2 intervention and 2 control subdistricts, using structured questions about delays. Six to ten times during the 18-month intervention period, local workers communicated four key messages to most intervention households in 292 villages: serious symptoms of suspected sepsis in children, a call-in center number for referral advice, a reliable transport hub, and upgrades to the local hospital.

RESULTS

Compared to baseline, endline results demonstrated a significant difference in the total delay between the onset of child's illness and seeking external care, with intervention families having shorter delays. Over 90% of mothers informed someone in the family, mainly the husband, about the sick child before acting to seek care. Delays due to transportation and receiving provider care were short and not different. Using a benchmark of seeking external care within 24 h of onset, only 14.14% of intervention households and 13.40% of control households were "timely" in seeking care. Approximately 78% of parents, similar for the two groups, sought care from a non-formal practitioner (the village doctor).

CONCLUSION

The results demonstrate that the delay in deciding to seek external care is most serious, and that communication strategies at the community level are necessary to increase the uptake of improved health services.

Self-reported morbidity and health service utilization in rural Tamil Nadu, India

In Tamil Nadu, India, improvements have been made toward developing a high-quality, universally accessible healthcare system. However, some rural residents continue to confront significant barriers to obtaining healthcare. The primary objective of this study was to investigate self-reported morbidity, health literacy, and healthcare preferences, utilization, and experiences in order to identify priority areas for government health policies and programs. Drawing on 66 semi-structured interviews and 300 household surveys (including 1693 individuals), administered in 26 rural villages in Tamil Nadu's Krishnagiri district, we found that the prevalence of self-reported major health conditions was 22.3%. There was a large burden of non-communicable and chronic diseases, and the most common major morbidities were: connective tissue problems (7.6%), nervous system and sense organ diseases (5.0%), and circulatory and respiratory diseases (2.5%). Increased age and decreased education level were associated with higher odds of reporting most diseases. Low health literacy levels resulted in individuals seeking care only once pain interfered with daily activities. As such, individuals' health-seeking behaviour depended on which strategy was believed to result in the fastest return to work using the fewest resources. Although government facilities were the most common healthcare access point, they were mistrusted; 48.8% and 19.2% of respondents perceived inappropriate treatment protocols and corruption, respectively, at public facilities. Conversely, 93.3% of respondents reported high treatment cost as the main barrier to accessing private facilities. Our results highlight that addressing the chronic and non-communicable disease burdens amongst rural populations in this context will require health policies and village-level programs that address the low health literacy and the issues of rural healthcare accessibility and acceptability.

Taken to Health Care Provider or Not, Under-Five Children Die of Preventable Causes: Findings from Cross-Sectional Survey and Social Autopsy in Rural India

Background:

Under-five children in India continue to die from causes that can either be treated or prevented. The data regarding causes of death, community care-seeking practices, and events prior to death are needed to guide and refine health policies for achieving national goals and targets.

Materials and Methods:

A cross-sectional survey covering rural areas of 16 districts from eight states across India was conducted to understand the causes of deaths and the health-seeking patterns of caregivers prior to the death of such children. Mothers of the deceased children were interviewed. The physician review process was used to assign cause of death. The qualitative data were analyzed as per standard methods, while STATA version 10 was used for analysis of quantitative data.

Findings:

A total of 1,488 death histories were captured through verbal autopsy. Neonatal etiologies, acute respiratory infection (ARI), and diarrhea accounted for approximately 63.1% of all deaths in the under-five age group. The causes of death in neonates showed that birth asphyxia, prematurity, and neonatal infections contributed to more than 67.5% of all neonatal deaths, while in children aged 29 days to 59 months, ARI and diarrhea accounted for 54.3% of deaths. Care providers of 52.6% of the neonates and 21.7% of infants and under-five children did not seek any medical care before the death of the child. Substantial delays in seeking care occurred at home and during transit. For those who received medical care, there was an apparent amongst in their caregivers toward private health providers.

Conclusion:

The deaths of neonates and postneonates taken to any health facilities highlight the need for providing equitable and high-quality health services in India. The findings could be used for policy planning and program refinement in India.

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.

Effect of residence on mothers' health care seeking behavior for common childhood illness in Northwest Ethiopia: a community based comparative cross--sectional study

Background

Children are at higher risk of acquiring infections and developing severe disease. This study assessed the health care seeking behavior and associated factors of urban and rural mothers for common childhood illness in Northwest Ethiopia.

Methods

A comparative community based cross-sectional study was conducted among urban and rural mothers living in the district. A multistage sampling technique was used to select the study participants. A pre-tested and structured questioner via interview was used to collect the data. Binary logistic regression analysis was used to identify associated factors. Odds ratio with 95% CI was computed to assess the strength of the associations.

Result

A total of 827 (274 urban and 553 rural) mothers were interviewed. Among these, 79.3% (95% CI: (76.5%, 82.06%)) of the mothers were sought health care in the district. Health care seeking behavior was higher among urban mothers (84.6%) than rural mothers (76.7%). Marital status, completion health extension package, and sex of child were significantly associated with health care seeking behavior of urban mothers. Whereas age of child, age and occupation of mothers, educational level of fathers, wealth quintile, and type of reported illness were significantly associated with rural mothers. Perceived severity of illness was significantly associated with both urban and rural mothers for health care seeking behavior.

Conclusion

The overall health seeking behaviors of mothers for common childhood illness was high. However, urban mothers seek health care more than rural. Socio Economic position and types of reported illness has an effect for health seeking behavior of rural mothers. Whereas child sex preference and graduation status for health extension package has an effect for health care seeking behavior of urban mothers. Work on strengthen accessibility of health care services in the rural mothers and increase awareness of mothers about the disadvantage of sex preferences will improve the health care seek behavior of families regardless of the severity of illness and types of illnesses.