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Lamshöft MM, Liheluka E, Ginski G, Lusingu JPA, Minja D, Gesase S, Mbwana J, Gesase G, Rautman L, Loag W, May J, Dekker D, Krumkamp R. Understanding pre-hospital disease management of fever and diarrhoea in children-Care pathways in rural Tanzania. Trop Med Int Health 2024; 29:706-714. [PMID: 38888511 DOI: 10.1111/tmi.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Many children in sub-Saharan Africa die from infectious diseases like malaria, pneumonia, and diarrhoea that can be prevented by early diagnosis, effective and targeted treatment. This study aimed to gain insights into case management practices by parents before they present their children to hospital. METHODS We conducted a cross-sectional study among 332 parents attending a district hospital with their under-fives symptomatic with fever and/or diarrhoea between November 2019 and July 2020 in rural Tanzania. Timely and targeted treatment was defined as seeking health care within 24 h of fever onset, and continued fluid intake in case of diarrhoea. RESULTS The main admission diagnoses were acute respiratory infections (61.8%), malaria (25.3%), diarrhoea (18.4%) and suspected sepsis (8.1%). The majority of children (91%) received treatment prior to admission, mostly antipyretics (75.6%), local herbal medicines (26.8%), and antibiotics (17.8%)-half of them without prescription from a clinician. For diarrhoea, the use of oral rehydration solution was rare (9.0%), although perceived as easily accessible and affordable. 49.4% of the parents presented their children directly to the hospital, 23.2% went to a pharmacy/drug shop and 19.3% to a primary health facility first. Malaria symptoms began mostly 3 days before the hospital visit; only 25.4% of febrile children visited any health facility within 24 h of disease onset. Prior use of local herbal medicine (AOR = 3.2; 95% CI 1.4-7.3), visiting the pharmacy (adjusted Odds Ratio [AOR] = 3.1; 95% confidence interval [CI]: 1.0-9.8), the dispensary being the nearest health facility (AOR = 3.0; 95% CI: 1.5-6.2), and financial difficulties (AOR = 2.2; 95% CI 1.1-4.5) were associated with delayed treatment. CONCLUSION This study suggests that antipyretics and antibiotics dispensed at pharmacies/drug shops, as well as use of local herbal medicines, delay early diagnosis and treatment, which can be life-threatening. Pharmacies/drug shops could be integrated as key focal points for sensitising community members on how to respond to paediatric illnesses and encourage the use of oral rehydration solutions.
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Affiliation(s)
- Maike Maria Lamshöft
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, DZIF, Hamburg-Borstel-Riems, Germany
- University Clinic Hamburg-Eppendorf, UKE, Hamburg, Germany
| | - Edwin Liheluka
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - Greta Ginski
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - John P A Lusingu
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - Daniel Minja
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - Samwel Gesase
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - Joyce Mbwana
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - George Gesase
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - Lydia Rautman
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- University Clinic Hamburg-Eppendorf, UKE, Hamburg, Germany
| | - Wibke Loag
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jürgen May
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, DZIF, Hamburg-Borstel-Riems, Germany
- University Clinic Hamburg-Eppendorf, UKE, Hamburg, Germany
| | - Denise Dekker
- Department for Implementation Research, Bernhard Nocht Institute for Tropical Medicine, One Health Bacteriology, Hamburg, Germany
| | - Ralf Krumkamp
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, DZIF, Hamburg-Borstel-Riems, Germany
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Rees CA, Ideh RC, Kisenge R, Kamara J, Coleman-Nekar YJG, Samma A, Godfrey E, Manji HK, Sudfeld CR, Westbrook AL, Niescierenko M, Morris CR, Whitney CG, Breiman RF, Duggan CP, Manji KP. Identifying neonates at risk for post-discharge mortality in Dar es Salaam, Tanzania, and Monrovia, Liberia: Derivation and internal validation of a novel risk assessment tool. BMJ Open 2024; 14:e079389. [PMID: 38365298 PMCID: PMC10875550 DOI: 10.1136/bmjopen-2023-079389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION The immediate period after hospital discharge carries a large burden of childhood mortality in sub-Saharan Africa. Our objective was to derive and internally validate a risk assessment tool to identify neonates discharged from the neonatal ward at risk for 60-day post-discharge mortality. METHODS We conducted a prospective observational cohort study of neonates discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania, and John F Kennedy Medical Centre in Monrovia, Liberia. Research staff called caregivers to ascertain vital status up to 60 days after discharge. We conducted multivariable logistic regression analyses with best subset selection to identify socioeconomic, demographic, clinical, and anthropometric factors associated with post-discharge mortality. We used adjusted log coefficients to assign points to each variable and internally validated our tool with bootstrap validation with 500 repetitions. RESULTS There were 2344 neonates discharged and 2310 (98.5%) had post-discharge outcomes available. The median (IQR) age at discharge was 8 (4, 15) days; 1238 (53.6%) were male. In total, 71 (3.1%) died during follow-up (26.8% within 7 days of discharge). Leaving against medical advice (adjusted OR [aOR] 5.62, 95% CI 2.40 to 12.10) and diagnosis of meconium aspiration (aOR 6.98, 95% CI 1.69 to 21.70) conferred the greatest risk for post-discharge mortality. The risk assessment tool included nine variables (total possible score=63) and had an optimism corrected area under the receiver operating characteristic curve of 0.77 (95% CI 0.75 to 0.80). A score of ≥6 was most optimal (sensitivity 68.3% [95% CI 64.8% to 71.5%], specificity 72.1% [95% CI 71.5% to 72.7%]). CONCLUSIONS A small number of factors predicted all-cause, 60-day mortality after discharge from neonatal wards in Tanzania and Liberia. After external validation, this risk assessment tool may facilitate clinical decision making for eligibility for discharge and the direction of resources to follow-up high risk neonates.
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Affiliation(s)
- Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Readon C Ideh
- Department of Pediatrics, John F Kennedy Medical Center, Monrovia, Liberia
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Julia Kamara
- Department of Pediatrics, John F Kennedy Medical Center, Monrovia, Liberia
| | | | - Abraham Samma
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Evance Godfrey
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Hussein K Manji
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
- Accident and Emergency Department, The Aga Khan Health Services, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Christopher R Sudfeld
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Boston, USA
| | - Adrianna L Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michelle Niescierenko
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia R Morris
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher P Duggan
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Boston, USA
- Center for Nutrition, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
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Garcia Gomez E, Igunza KA, Madewell ZJ, Akelo V, Onyango D, El Arifeen S, Gurley ES, Hossain MZ, Chowdhury MAI, Islam KM, Assefa N, Scott JAG, Madrid L, Tilahun Y, Orlien S, Kotloff KL, Tapia MD, Keita AM, Mehta A, Magaço A, Torres-Fernandez D, Nhacolo A, Bassat Q, Mandomando I, Ogbuanu I, Cain CJ, Luke R, Kamara SIB, Legesse H, Madhi S, Dangor Z, Mahtab S, Wise A, Adam Y, Whitney CG, Mutevedzi PC, Blau DM, Breiman RF, Tippett Barr BA, Rees CA. Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1-59 months. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002494. [PMID: 38329969 PMCID: PMC10852234 DOI: 10.1371/journal.pgph.0002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
Delays in illness recognition, healthcare seeking, and in the provision of appropriate clinical care are common in resource-limited settings. Our objective was to determine the frequency of delays in the "Three Delays-in-Healthcare", and factors associated with delays, among deceased infants and children in seven countries with high childhood mortality. We conducted a retrospective, descriptive study using data from verbal autopsies and medical records for infants and children aged 1-59 months who died between December 2016 and February 2022 in six sites in sub-Saharan Africa and one in South Asia (Bangladesh) and were enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS). Delays in 1) illness recognition in the home/decision to seek care, 2) transportation to healthcare facilities, and 3) the receipt of clinical care in healthcare facilities were categorized according to the "Three Delays-in-Healthcare". Comparisons in factors associated with delays were made using Chi-square testing. Information was available for 1,326 deaths among infants and under 5 children. The majority had at least one identified delay (n = 854, 64%). Waiting >72 hours after illness recognition to seek health care (n = 422, 32%) was the most common delay. Challenges in obtaining transportation occurred infrequently when seeking care (n = 51, 4%). In healthcare facilities, prescribed medications were sometimes unavailable (n = 102, 8%). Deceased children aged 12-59 months experienced more delay than infants aged 1-11 months (68% vs. 61%, P = 0.018). Delays in seeking clinical care were common among deceased infants and children. Additional study to assess the frequency of delays in seeking clinical care and its provision among children who survive is warranted.
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Affiliation(s)
- Elisa Garcia Gomez
- Emory University School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | | | - Zachary J. Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kazi Munisul Islam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nega Assefa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | | | - Lola Madrid
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Yenenesh Tilahun
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Stian Orlien
- College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland
- Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amilcar Magaço
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - David Torres-Fernandez
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | | | | | - Ronita Luke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- Department of Obstetrics and Gynaecology, Rahima Mossa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmin Adam
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia G. Whitney
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Portia C. Mutevedzi
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Dianna M. Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Chris A. Rees
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
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Chi H, Eom YJ, Jung S, Kim J, Jeong J, Kim R. Maternal Decision-Making Power and Care-Seeking Behaviors for Acutely Ill Children: A Multilevel Analysis of 33 Sub-Saharan African Countries. Am J Trop Med Hyg 2024; 110:370-378. [PMID: 38190745 PMCID: PMC10859818 DOI: 10.4269/ajtmh.23-0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/26/2023] [Indexed: 01/10/2024] Open
Abstract
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.
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Affiliation(s)
- Hyejun Chi
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Sohee Jung
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Jinseo Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
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Aragaw FM, Teklu RE, Alemayehu MA, Derseh NM, Agimas MC, Shewaye DA, Birhanie AL, Tsega SS, Argaw GS, Tesfaye AH. Magnitude and determinant of healthcare-seeking behavior for childhood acute respiratory tract infections in Ethiopia: a cross-sectional study. BMC Pediatr 2024; 24:3. [PMID: 38172730 PMCID: PMC10763025 DOI: 10.1186/s12887-023-04463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
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.
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Affiliation(s)
- Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Rediet Eristu Teklu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meron Asmamaw Alemayehu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Mekonnen Derseh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Alayu Shewaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Atalay Liknaw Birhanie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sintayehu Simie Tsega
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girum Shibeshi Argaw
- Department Of Nursing, College Of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Odimegwu C, Muchemwa M, Akinyemi JO. Systematic review of multilevel models involving contextual characteristics in African demographic research. JOURNAL OF POPULATION RESEARCH 2023. [DOI: 10.1007/s12546-023-09305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
AbstractMultilevel modelling has become a popular analytical approach for many demographic and health outcomes. The objective of this paper is to systematically review studies which used multilevel modelling in demographic research in Africa in terms of the outcomes analysed, common findings, theoretical rationale, questions addressed, methodological approaches, study design and data sources. The review was conducted by searching electronic databases such as Ebsco hosts, Science Direct, ProQuest, Scopus, PubMed and Google scholar for articles published between 2010 and 2021. Search terms such as neighbourhood, social, ecological and environmental context were used. The systematic review consisted of 35 articles, with 34 being peer-reviewed journal articles and 1 technical report. Based on the systematic review community-level factors are important in explaining various demographic outcomes. The community-level factors such as distance to the health facility, geographical region, place of residence, high illiteracy rates and the availability of maternal antenatal care services influenced several child health outcomes. The interpretation of results in the reviewed studies mainly focused on fixed effects rather than random effects. It is observed that data on cultural practices, values and beliefs, are needed to enrich the robust evidence generated from multilevel models.
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Terefe B, Mulat B, Shitu K, Assimamaw NT. 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. BMC Public Health 2023; 23:579. [PMID: 36978028 PMCID: PMC10045107 DOI: 10.1186/s12889-023-15493-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
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.
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Affiliation(s)
- Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Bezawit Mulat
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kegnie Shitu
- Department of Health Education and Behavioral Sciences, Institute of Public Health, of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nega Tezera Assimamaw
- Department of Pediatrics and Child Health, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Madera-Garcia V, Coalson JE, Subelj M, Bell ML, Hayden MH, Agawo M, Munga S, Ernst KC. Self-Reported Symptoms at Last Febrile Illness as a Predictor of Treatment-Seeking in Western Kenya: A Cross-Sectional Study. Am J Trop Med Hyg 2023; 108:212-220. [PMID: 36410323 PMCID: PMC9833091 DOI: 10.4269/ajtmh.21-0447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Timely treatment-seeking behavior can reduce morbidity and mortality due to infectious diseases. Patterns of treatment-seeking behavior can differ by access to health care, and perceptions of disease severity and symptoms. We evaluated the association between self-reported symptoms at last illness and the level of treatment-seeking behaviors. We analyzed cross-sectional data from 1,037 participants from the lowlands and highlands of Western Kenya from 2015 using logistic regression models. There was considerable heterogeneity in the symptoms and treatment-seeking behaviors reported among individuals who were febrile at their last illness. A greater number of self-reported categories of symptoms tended to be associated with a higher likelihood of treatment-seeking in both sites. Participants were significantly more likely to seek treatment if they reported fever, aches, and digestive symptoms at last illness than just fever and aches or fever alone, but the frequency of treatment-seeking for fever in combination with aches and respiratory symptoms did not follow a consistent pattern. Among those who sought treatment, most used a formal source, but the patterns were inconsistent across sites and by the number of symptoms categories. Understanding the drivers of treatment-seeking behavior after febrile illness is important to control and treat infectious diseases in Kenya.
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Affiliation(s)
| | - Jenna E. Coalson
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana
| | - Maja Subelj
- National Institute of Public Health, University of Ljubljana, Ljubljana, Slovenia
| | - Melanie L. Bell
- College of Public Health, University of Arizona, Tucson, Arizona
| | - Mary H. Hayden
- Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, Colorado
| | - Maurice Agawo
- Kenya Medical Research Institute, Kisian Research Station, Kenya
| | - Stephen Munga
- Kenya Medical Research Institute, Kisian Research Station, Kenya
| | - Kacey C. Ernst
- College of Public Health, University of Arizona, Tucson, Arizona
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Chilot D, Shitu K, Gela YY, Getnet M, Mulat B, Diress M, Belay DG. Factors associated with healthcare-seeking behavior for symptomatic acute respiratory infection among children in East Africa: a cross-sectional study. BMC Pediatr 2022; 22:662. [PMID: 36380283 PMCID: PMC9664707 DOI: 10.1186/s12887-022-03680-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although there has been promising progress in the reduction of child mortality from ARI, the magnitude is high yet, especially in East Africa. Since mothers/guardians decide upon the type and frequency of healthcare services for children, their good healthcare-seeking behavior could prevent acute respiratory infections (ARI) related mortality and morbidity. This study aimed to investigate the pooled prevalence and factors associated with healthcare-seeking behavior of children younger than five years with ARI symptoms by using data from nationally representative surveys of East Africa. Methods We analyzed secondary data based on the eleven East African Demographic and Health Survey data. Both Individual and community level variables were considered for this study and a multilevel binary logistic regression model was fitted to identify associated factors of children’s healthcare-seeking behavior for ARI symptoms. STATA V.14 software was used to clean, recode and analyze the data. All variables with a p-value = 0.2 in the bi-variable analysis were considered for the multivariable multilevel analysis. Adjusted OR (AOR) with 95% CI was reported to reveal significantly associated factors in the multivariable multilevel analysis. Result The overall prevalence of healthcare-seeking behavior of under-five children for ARI symptoms was 64.4% in East Africa. In the multilevel analysis, the following characteristics were found to be the most important factors of children healthcare seeking behavior for ARI symptoms (P < 0.05): Rural residence [AOR = 0.51, 95% CI (0.37–0.65)], high community level media usage [AOR = 1.63, 95% CI (1.49–1.79)], high community level women education [AOR = 1.51, 95% CI (1.39–1.66)], primary education [AOR = 1.62, 95% CI (1.45–1.82)], secondary education and above [AOR = 1.99, 95% CI (1.71–2.32)], working mother [AOR = 1.33, 95% CI (1.20–1.48)], unmarried women [AOR = 1.15, 95% CI (1.04–1.27)], media access [AOR = 1.43, 95% CI (1.20–1.58)], richest [AOR = 1.39, 95% CI (1.29–1.51)], distance to health facility not a big problem [AOR = 1.11, 95% CI (1.02–1.21)], Place of delivery at health facilities [AOR = 1.77, 95% CI (1.60–1.95)], age of child 7–23 months [AOR = 1.59, 95% CI (1.39–1.82)], age of child 24–59 months [AOR = 1.24, 95% CI (1.09–1.41)] in comparison with children aged 0–6 months, family size > 10 [AOR = 1.53, 95% CI (1.22–1.92)]. Conclusions and recommendations The overall prevalence of children’s healthcare-seeking behavior for ARI symptoms was found relatively low in East Africa, ARI symptoms were determined by individual-level variables and community-level factors. Targeted interventions are needed to improve socioeconomic and health systems to overcome the problem of acute respiratory infection in children. Special attention is required to empower local health staff and health facilities to provide proper diagnosis and management of ARI cases in East Africa.
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A Cross-Sectional Survey on the Malaria Control and Prevention Knowledge, Attitudes, and Practices of Caregivers of Children Under-5 in the Western Area of Sierra Leone. Trop Med Infect Dis 2022; 7:tropicalmed7070120. [PMID: 35878132 PMCID: PMC9319430 DOI: 10.3390/tropicalmed7070120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Children under 5 years of age are the most vulnerable to malaria infection, and they suffer serious complications. Sierra Leone is one of the countries with the highest malaria burden in the world. This study aimed to assess the knowledge, attitudes, and practices (KAPs) toward malaria control and prevention among caregivers of children under 5 in the Western Area of Sierra Leone. (2) Methods: A cross-sectional survey was conducted among caregivers of children under-5 visiting the out-patient department of six selected hospitals/community health centers. Data were collected via questionnaire interviews with 350 caregivers. (3) Results: A total of 97.1% of the respondents were women and the majority of them were young mothers; 46.3% of respondents were unemployed; and 27.1% received no education. Only 1.4% accessed malaria related information from the internet/social media. This KAPs survey indicated that a misconception of the cause, transmission, and clinical symptoms of malaria; unawareness of its lethality and its severity; and inappropriate prevention and treatment behaviors, such as self-medicating, were still in existence among some caregivers. However, a positive correlation in knowledge−attitudes (rs = 0.13, p < 0.05) and in attitudes−practices (rs = 0.45, p < 0.001) was revealed. The caregivers, being mothers and having at least a secondary education, demonstrated positive attitudes and practices. Meanwhile, more urban caregivers (79.8%) followed a complete malaria treatment course of artemisinin-based combination therapies than the rural (63.3%), but in view of insecticide treated net use, more rural caregivers presented positive attitudes (85.3%) and practices (70.1%) than the urban (69.9%, 52.0%). (4) Conclusions: For better protection of children under-5 against lethal malaria, it is essential to provide better guidance at the community level for their caregivers, especially young mothers, in order to reduce some misconceptions and inappropriate behaviors. An increase in education and employment opportunities for women, establishment of an accessible community-based malaria counselling service, and construction of an effective communication channel are also needed.
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Lewis TP, Ndiaye Y, Manzi F, Kruk ME. 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. J Glob Health 2022; 12:04025. [PMID: 35356662 PMCID: PMC8932460 DOI: 10.7189/jogh.12.04025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Todd P Lewis
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, MA, USA
| | - Youssoupha Ndiaye
- Division of Planning, Research and Statistics, Ministry of Health and Social Action, Dakar, Senegal
| | - Fatuma Manzi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, MA, USA
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Liyew B, Tarekegn GE, Kassew T, Tsegaye N, Asfaw MG, Tilahun AD, Tadesse AZ, Alamneh TS. Individual and community-level factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia: A multilevel analysis. PLoS One 2022; 17:e0264707. [PMID: 35298490 PMCID: PMC8929549 DOI: 10.1371/journal.pone.0264707] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Early diagnosis and treatment of childhood fever are essential for controlling disease progression and death. However, the Treatment-seeking behaviour of caregivers is still a significant challenge in rural parts of the African region. This study aimed to assess individual and community-level factors associated with treatment-seeking behaviours among caregivers of febrile under-five age children in Ethiopia. Method The recent Ethiopian Demographic and Health Survey data (EDHS 2016) was used for the study. The survey collected information among 1,354 under-five children who had a fever within two weeks before the survey. The data were extracted, cleaned, and recoded using STATA version 14. Multilevel logistic regressions were used to determine the magnitude and associated factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia. Four models were built to estimate both fixed and random effects of individual and community-level factors between cluster variations on treatment-seeking behaviour. The Adjusted Odds Ratios with 95% Confidence Intervals (CI) of the best-fitted model were reported at p<0.05. Result This study revealed that 491 (36.26%) caregivers seek treatment for their febrile children. Living in metropolitan and small peripheral regions, delivery at health institutions, being poorer, middle and richer wealth quintiles, having a child with diarrhoea, cough, short rapid breathing, and wasting were positively associated with treatment-seeking behaviour of caregivers. Conclusion The caregivers had poor treatment-seeking behaviour for their febrile children in Ethiopia. Health education programmers should emphasise the importance of seeking early treatment, taking action on childhood febrile illness signs.
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Affiliation(s)
- Bikis Liyew
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Gebrekidan Ewnetu Tarekegn
- Department of Biostatistics and Epidemiology, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tilahun Kassew
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Netsanet Tsegaye
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Marye Getnet Asfaw
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ambaye Dejen Tilahun
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayalew Zewdie Tadesse
- Department of Emergency Medicine and Critical Care, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Biostatistics and Epidemiology, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Budu E, Seidu AA, Ameyaw EK, Agbaglo E, Adu C, Commey F, Dickson KS, Adde KS, Ahinkorah BO. Factors associated with healthcare seeking for childhood illnesses among mothers of children under five in Chad. PLoS One 2021; 16:e0254885. [PMID: 34351941 PMCID: PMC8341616 DOI: 10.1371/journal.pone.0254885] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 07/06/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Felicia Commey
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Kenneth Setorwu Adde
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Mburu CM, Bukachi SA, Shilabukha K, Tokpa KH, Ezekiel M, Fokou G, Bonfoh B, Kazwala R. Determinants of treatment-seeking behavior during self-reported febrile illness episodes using the socio-ecological model in Kilombero District, Tanzania. BMC Public Health 2021; 21:1075. [PMID: 34090402 PMCID: PMC8180143 DOI: 10.1186/s12889-021-11027-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 05/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Febrile diseases in Sub-Saharan Africa cause acute and chronic illness. Co-infections are common and these diseases have a complex etiology that includes zoonoses. For the implementation of appropriate treatment and control strategies, determinants of lay treatment-seeking behavior by the affected communities need to be understood. The objective of this study was to explore, using the socio-ecological model, the determinants of treatment-seeking actions among self-identified febrile illness cases in the Kilombero District of Tanzania. Methods Thirty-nine in-depth interviews were conducted with 28 men and 11 women in three villages in Kilombero district. These villages were purposively selected due to malaria endemicity in the area, animal husbandry practices, and proximity to livestock-wildlife interaction, all risk factors for contracting febrile zoonotic infections. Thematic analysis was conducted on the interviews to identify the key determinants of treatment-seeking actions. Results Study participants attributed febrile illnesses to malaria, typhoid and urinary tract infections. Treatment-seeking behavior was an iterative process, influenced by individual, socio-cultural, ecological and policy factors. Age, expendable income, previous history with a febrile illness, perceptions on disease severity, seasonal livelihood activities and access to timely healthcare were some of the determinants. Self-treatment with pharmaceutical drugs and herbs was usually the initial course of action. Formal healthcare was sought only when self-treatment failed and traditional healers were consulted after the perceived failure of conventional treatment. Delays in seeking appropriate health care and the consultation of medically unqualified individuals was very common. Conclusion The results imply that treatment-seeking behavior is shaped by multiple factors across all levels of the socio-ecological model. Public policy efforts need to focus on facilitating prompt health care seeking through community education on the complicated etiology of febrile illnesses. Improved access to timely treatment and better differential diagnostics by health professionals are essential to ensure correct and appropriate treatment and to reduce reliance of patients on unqualified persons. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11027-w.
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Affiliation(s)
- Caroline M Mburu
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya.
| | - Salome A Bukachi
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Khamati Shilabukha
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Kathrin H Tokpa
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Mangi Ezekiel
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gilbert Fokou
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
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Umoke PCI, Umoke M, Eyo N, Ugwu Mbbs A, Okeke E, Nwalieji CA, Agbaje SO, Onwe RN, Ekeh DO, Umoke UG, Agu MN, Okide CC. Delay in health-seeking behaviour: Implication to yellow fever outcome in the 2019 outbreak in Nigeria. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:703-711. [PMID: 33761167 DOI: 10.1111/hsc.13329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/26/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
Yellow fever is a vaccine-preventable acute viral disease that can rapidly spread and cause serious public health impact. Delay in seeking health care from health facilities is a potential risk of prolonged disease spread. Therefore, this study assessed the delay in health-seeking behaviour and implications for yellow fever outcomes in the 2019 outbreak in Nigeria. Furthermore, the study examined the factors associated with delayed yellow fever vaccine uptake. A retrospective study was conducted from January to December 2019 using 137 cases recorded in the WHO database. The data were analysed using descriptive (frequency and percentages) and the Chi-square test. The results were significant at p < 0.05. Results showed a low uptake of yellow fever vaccine (24.1%) among patients and a median total health-seeking delay of 7 [IQR 7, 9] days. The delay was more among the older age ≥40 years (12 [IQR 12, 29]), females (8 [IQR 8, 11], and rural inhabitants 7 [IQR7, 9], particularly in Izzi LGA (9 [IQR 9, 16] than the other subgroups. Patients' location or place of residence was significantly associated with the yellow fever vaccine uptake (p < 0.000*), and delay (p = 0.003*). Conclusively, the low vaccine uptake was due to the delay in health-seeking behaviour. Thus, the healthcare system in Nigeria needs to intensify mass participation in immunisation programmes. Interventions that promote behavioural change towards immunisation are required. Also, health promotion campaigns to educate rural people on desirable health-seeking behaviour are needed.
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Affiliation(s)
- Prince C I Umoke
- Department of Human Kinetics and Health Education, University of Nigeria, Nsukka, Nigeria
| | - MaryJoy Umoke
- School Health Programme Unit, Department of Public Health, Ebonyi State Ministry of Health, Abakaliki, Nigeria
| | | | | | | | - Chioma A Nwalieji
- School Health Programme Unit, Department of Public Health, Ebonyi State Ministry of Health, Abakaliki, Nigeria
| | - Samson O Agbaje
- Department of Human Kinetics and Health Education, University of Nigeria, Nsukka, Nigeria
| | - Rosemary N Onwe
- Department of Economics, Ebonyi State University, Abakaliki, Nigeria
| | - David O Ekeh
- Education Foundation, Alex Ekwueme Federal University NdufuAlike, Ikwo, Nigeria
| | - Ugochi G Umoke
- University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria
| | - Martins N Agu
- Ananda Marga Universal Relief Team Foundation, Abakaliki, Nigeria
| | - Charity C Okide
- Department of Adult Education and Extramural Studies, University of Nigeria, Nsukka, Nigeria
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A Scoping Review of Selected Studies on Predictor Variables Associated with the Malaria Status among Children under Five Years in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042119. [PMID: 33671594 PMCID: PMC7927088 DOI: 10.3390/ijerph18042119] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/21/2022]
Abstract
Background/Purpose: In recent times, Sub-Saharan Africa (SSA) had been rated by the World Health Organization (WHO) as the most malaria-endemic region in the world. Evidence synthesis of the factors associated with malaria among children aged under-five in SSA is urgently needed. This would help to inform decisions that policymakers and executors in the region need to make for the effective distribution of scarce palliative resources to curb the spread of the illness. This scoping review is aimed at identifying studies that have used multivariate classical regression analysis to determine the predictors associated with malaria among children under five years old in SSA. Methods/Design: The search terms followed population, intervention, comparator, outcome, timing, setting (PICOTS), and were used in searching through the following databases: PubMed, MEDLINE, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, and Measure DHS. The databases were searched for published articles from January 1990 to December 2020. Results: Among the 1154 studies identified, only thirteen (13) studies met the study’s inclusion criteria. Narrative syntheses were performed on the selected papers to synchronize the various predictors identified. Factors ranging from child-related (age, birth order and use of a bed net), parental/household-related (maternal age and education status, household wealth index) and community-related variables (community wealth status, free bed net distribution) were some of the identified significant predictors. Conclusions: It is timely to have a synthesis of predictors that influence the malaria status of children under-five in SSA. The outcome of the review will increase the knowledge of the epidemiology of morbidity that will form the basis for designing efficient and cost-effective distribution of palliatives and control of malaria in SSA.
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Ahinkorah BO, Budu E, Seidu AA, Agbaglo E, Adu C, Ameyaw EK, Ampomah IG, Archer AG, Kissah-Korsah K, Yaya S. Barriers to healthcare access and healthcare seeking for childhood illnesses among childbearing women in sub-Saharan Africa: A multilevel modelling of Demographic and Health Surveys. PLoS One 2021; 16:e0244395. [PMID: 33556057 PMCID: PMC7870045 DOI: 10.1371/journal.pone.0244395] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/08/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction The success of current policies and interventions on providing effective access to treatment for childhood illnesses hinges on families’ decisions relating to healthcare access. In sub-Saharan Africa (SSA), there is an uneven distribution of child healthcare services. We investigated the role played by barriers to healthcare accessibility in healthcare seeking for childhood illnesses among childbearing women in SSA. Materials and methods Data on 223,184 children under five were extracted from Demographic and Health Surveys of 29 sub-Saharan African countries, conducted between 2010 and 2018. The outcome variable for the study was healthcare seeking for childhood illnesses. The data were analyzed using Stata version 14.2 for windows. Chi-square test of independence and a two-level multivariable multilevel modelling were carried out to generate the results. Statistical significance was pegged at p<0.05. We relied on ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) statement in writing the manuscript. Results Eighty-five percent (85.5%) of women in SSA sought healthcare for childhood illnesses, with the highest and lowest prevalence in Gabon (75.0%) and Zambia (92.6%) respectively. In terms of the barriers to healthcare access, we found that women who perceived getting money for medical care for self as a big problem [AOR = 0.81 CI = 0.78–0.83] and considered going for medical care alone as a big problem [AOR = 0.94, CI = 0.91–0.97] had lower odds of seeking healthcare for their children, compared to those who considered these as not a big problem. Other factors that predicted healthcare seeking for childhood illnesses were size of the child at birth, birth order, age, level of community literacy, community socio-economic status, place of residence, household head, and decision-maker for healthcare. Conclusion The study revealed a relationship between barriers to healthcare access and healthcare seeking for childhood illnesses in sub-Saharan Africa. Other individual and community level factors also predicted healthcare seeking for childhood illnesses in sub-Saharan Africa. This suggests that interventions aimed at improving child healthcare in sub-Saharan Africa need to focus on these factors.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, Australia
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion, and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Irene Gyamfuah Ampomah
- College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, Australia
| | - Anita Gracious Archer
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Kwaku Kissah-Korsah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
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Ng'ambi W, Mangal T, Phillips A, Colbourn T, Mfutso-Bengo J, Revill P, Hallett TB. Factors associated with healthcare seeking behaviour for children in Malawi: 2016. Trop Med Int Health 2020; 25:1486-1495. [PMID: 32981174 DOI: 10.1111/tmi.13499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Wingston Ng'ambi
- College of Medicine, Health Economics and Policy Unit, University of Malawi, Lilongwe, Malawi
| | | | | | | | - Joseph Mfutso-Bengo
- College of Medicine, Health Economics and Policy Unit, University of Malawi, Lilongwe, Malawi
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Adedokun ST, Yaya S. Factors influencing mothers' health care seeking behaviour for their children: evidence from 31 countries in sub-Saharan Africa. BMC Health Serv Res 2020; 20:842. [PMID: 32894107 PMCID: PMC7487813 DOI: 10.1186/s12913-020-05683-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost half of the estimated 5.3 million deaths of under-five children in 2018 occurred in sub-Saharan Africa with morbidity contributing substantially to these deaths. Seeking medical care for children has been described as an important measure of reducing mortality occasioned by morbidity. This study examined factors influencing mothers' health seeking behaviour for their children in sub-Saharan Africa. METHODS This study made use of data from Demographic and Health Surveys (DHS) of 31 countries in sub-Saharan Africa. The study involved 75,982 children who received or did not receive measles vaccine and 93,142 children who sought or did not seek medical care when affected by fever or cough and diarrhoea. Binary logistic regression was applied in the analysis. RESULTS Most of the children (74%) received measles vaccine while less than one-fifth sought medical care for fever or cough (16%) and diarrhoea (10%). Majority of the children of women who received measles vaccine and sought medical care when they had fever or cough are from richest households. Children of women with primary and secondary or higher education, children of working women and children of women that attended antenatal care during pregnancy are more likely to seek medical care for fever or cough. While children of women who live in urban areas and children of second or higher order of birth are less likely to receive measles vaccine, children aged 24-35 months and those who were of average size at birth are less likely to seek medical care for diarrhoea. CONCLUSIONS This study has revealed that mothers' health care seeking behaviour for their children is influenced by social, maternal and child factors. Any intervention aimed at improving child health in sub-Sharan Africa should take these factors into consideration.
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Affiliation(s)
- Sulaimon T Adedokun
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, The University of Oxford, Oxford, UK.
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Nakovics MI, Brenner S, Bongololo G, Chinkhumba J, Kalmus O, Leppert G, De Allegri M. Determinants of healthcare seeking and out-of-pocket expenditures in a "free" healthcare system: evidence from rural Malawi. HEALTH ECONOMICS REVIEW 2020; 10:14. [PMID: 32462272 PMCID: PMC7254643 DOI: 10.1186/s13561-020-00271-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/08/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND Monitoring financial protection is a key component in achieving Universal Health Coverage, even for health systems that grant their citizens access to care free-of-charge. Our study investigated out-of-pocket expenditure (OOPE) on curative healthcare services and their determinants in rural Malawi, a country that has consistently aimed at providing free healthcare services. METHODS Our study used data from two consecutive rounds of a household survey conducted in 2012 and 2013 among 1639 households in three districts in rural Malawi. Given our explicit focus on OOPE for curative healthcare services, we relied on a Heckman selection model to account for the fact that relevant OOPE could only be observed for those who had sought care in the first place. RESULTS Our sample included a total of 2740 illness episodes. Among the 1884 (68.75%) that had made use of curative healthcare services, 494 (26.22%) had incurred a positive healthcare expenditure, whose mean amounted to 678.45 MWK (equivalent to 2.72 USD). Our analysis revealed a significant positive association between the magnitude of OOPE and age 15-39 years (p = 0.022), household head (p = 0.037), suffering from a chronic illness (p = 0.019), illness duration (p = 0.014), hospitalization (p = 0.002), number of accompanying persons (p = 0.019), wealth quartiles (p2 = 0.018; p3 = 0.001; p4 = 0.002), and urban residency (p = 0.001). CONCLUSION Our findings indicate that a formal policy commitment to providing free healthcare services is not sufficient to guarantee widespread financial protection and that additional measures are needed to protect particularly vulnerable population groups.
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Affiliation(s)
- Meike Irene Nakovics
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Stephan Brenner
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Grace Bongololo
- Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi
| | - Jobiba Chinkhumba
- University of Malawi College of Medicine, Blantyre, Southern Region Malawi
| | - Olivier Kalmus
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Gerald Leppert
- German Institute for Development Evaluation (DEval), Bonn, Germany
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
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Tesfahunegn A, Zenebe D, Addisu A. Determinants of malaria treatment delay in northwestern zone of Tigray region, Northern Ethiopia, 2018. Malar J 2019; 18:358. [PMID: 31706356 PMCID: PMC6842532 DOI: 10.1186/s12936-019-2992-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 11/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally malaria affects 212 million people and causes 438,000 deaths each year. Ensuring early and timely treatment of malaria is important for preventing and controlling of life-threatening complications and further transmission. Even though malaria treatment is widely available in Ethiopia, 47-84% of patients present after 24 h of onset of first symptoms. This study assessed the determinants of delay for malaria treatment in Tigray, Ethiopia. METHODS A health facility-based case-control study design in northwestern zone of Tigray was conducted from September 2018 to January 2019. All the study participants enrolled were confirmed malaria patients (by microscopy or rapid diagnostic test) and who sought treatment. Cases were defined as malaria patients who sought treatment after 24 h of the onset of the first symptom and control were those who sought treatment within 24 h onset of symptom. A structured questionnaire was used to collect data on the determinants of malaria treatment delay. Data were entered into EpiInfo 7.0 and exported to SPSS 20.0 for analysis. Binary logistic regression was computed to identify predictors of delay for malaria treatment. RESULTS In total 161 cases and 161 controls were identified. Being residents of Tahtay Adyabo district (AOR = 2.84, 95% CI 1.29-6.27), having no formal education (AOR = 2.39, 95% CI 1.09-5.22), the decisions to seek health care being taken by the patient (AOR = 2.38 95% CI 1.09-5.2), the decisions to seek health care being taken by their fathers (AOR = 2.52, 95% CI 1.13-5.62), and having good knowledge about malaria symptoms (AOR = 2.02, 95% CI 1.21-3.39) were found determinants of delay for malaria treatment. CONCLUSION In this study, delays in obtaining treatment for malaria were associated with having no formal education, knowing about the signs and symptoms of malaria, living in Tahtay Adyabo district, and decision-making on seeking malaria treatment. The results suggests having treatment commenced at sites closer to the community and strengthened awareness-raising activity about the importance of early seeking for all with malaria-like symptoms, especially for household heads would contribute to improved treatment and reduced complications from malaria.
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Affiliation(s)
- Afewerki Tesfahunegn
- Epidemiology Department, School of Public Health, Mekelle University, Mekelle, Ethiopia.
| | - Dawit Zenebe
- Epidemiology Department, School of Public Health, Mekelle University, Mekelle, Ethiopia
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Effects of insecticide-treated net access and use on infant mortality in Malawi: A pooled analysis of demographic health surveys. Prev Med 2019; 127:105790. [PMID: 31398410 DOI: 10.1016/j.ypmed.2019.105790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/30/2019] [Accepted: 08/06/2019] [Indexed: 11/21/2022]
Abstract
Malaria continues to be among the top causes of death in children and insecticide-treated nets (ITNs) are considered among the most effective malaria control methods. However, information on the association between universal ITN coverage and infant mortality is limited. A Cox proportional hazard model was applied to Malawi Demographic and Health Surveys to determine the association between ITN access and use and infant mortality between 2004 and 2015-2016. The overall infant mortality rate for the entire period was 47.9/1000 live births. Infants from the ITN-user households exhibited a lower risk of mortality [adjusted Hazard Ratio (aHR) = 0.61, 95% Confidence Interval (CI) = 0.44-0.85] than those from the ITN-nonuser households. Similarly, the infants from the high-access households exhibited a lower risk of death (aHR = 0.63, 95% CI = 0.46-0.86) than those from the no-access households. Infants from the ITN-user and high-access households exhibited a significantly lower risk of death (aHR = 0.57, 95% CI = 0.40-0.82) than those from the ITN-nonuser and no-access households. The relationship between ITN access and use and infant mortality was significant among female infants with a second or higher birth order and interval of ≥2 years. The findings of the present population-based study emphasized the importance of ITN access and use in providing optimal protection against malaria to infants in Malawi. Malaria control programs should ensure high ITN access and use in Malawi to reduce infant mortality.
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Li J, Berg CJ, Kramer MR, Haardörfer R, Zlotorzynska M, Sanchez TH. An Integrated Examination of County- and Individual-Level Factors in Relation to HIV Pre-exposure Prophylaxis Awareness, Willingness to Use, and Uptake Among Men Who Have Sex with Men in the US. AIDS Behav 2019; 23:1721-1736. [PMID: 30430340 DOI: 10.1007/s10461-018-2334-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study explored the extent to which county- and individual-level factors were associated with awareness, willingness to use, and use of pre-exposure prophylaxis (PrEP) among US men who have sex with men (MSM). We conducted multilevel analyses using a sample of 8338 MSM residing in 1257 US counties drawn from the 2014-2015 American Men's Internet Survey to examine these associations, with focuses on variation in PrEP outcomes across counties and proportion variation explained by county-level factors (HIV prevalence, racial composition, median household income, income inequality, health insurance coverage). Results showed that PrEP awareness varied moderately across counties (intraclass correlation coefficients [ICC] = 7.7%), willingness to use did not vary; however, the actual use varied substantially (ICC = 20.7%). Half of the variation in awareness and use was explained by county-level factors. Higher median household income was associated with greater likelihood of awareness and use. Higher income inequality was associated with greater likelihood of PrEP awareness. Findings can inform the development of multilevel interventions to address PrEP uptake among MSM and identify communities where structural intervention is most needed.
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Affiliation(s)
- Jingjing Li
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, USA
- Department of Epidemiology, School of Health Sciences, Wuhan University, Luojiashan, Wuhan, Hubei, People's Republic of China
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, USA
| | - Maria Zlotorzynska
- Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Travis H Sanchez
- Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
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Nkoka O, Chuang TW, Chen YH. Multilevel Analysis of Factors Associated with Treatment-Seeking Behaviors among Caregivers with Febrile Children in Malawi. Am J Trop Med Hyg 2019; 100:1454-1465. [PMID: 30994089 PMCID: PMC6553897 DOI: 10.4269/ajtmh.18-0900] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Early diagnosis and treatment of childhood fever, an important sign of potentially serious infections such as malaria, is essential for controlling disease progression, and ultimately, preventing deaths. This study examined individual- and community-level factors associated with treatment-seeking behaviors and promptness in these behaviors among caregivers of febrile under-five children in Malawi. The 2015-2016 Malawi Demographic Health Survey was used to analyze a nationally representative sample of 4,133 under-five children who had fever within 2 weeks before the survey. A multilevel logistic regression model was used to examine the association between individual- and community-level factors and treatment-seeking behaviors. Approximately 67.3% of the caregivers reported seeking treatment for their febrile child, whereas only 46.3% reported promptly seeking treatment. Children from communities with moderate and high percentages of educated caregivers were more likely to be taken for treatment (adjusted odds ratio [aOR] = 1.26, 95% CI = 1.01-1.58 and aOR = 1.31, 95% CI = 1.02-1.70, respectively) than those from communities with a low percentage of educated caregivers. Children from communities with moderate and high percentages of caregivers complaining about the distance to a health facility were less likely to be taken for treatment (aOR = 0.74, 95% CI = 0.58-0.96 and aOR = 0.67, 95% CI = 0.51-0.88, respectively). At the individual level, having a cough in the last 2 weeks, region, religion, and having better health behaviors in other health dimensions were associated with fever treatment-seeking behaviors among Malawian caregivers. Programs aimed at improving treatment-seeking behaviors should consider these factors and the regional variations observed in this study.
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Affiliation(s)
- Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Ting-Wu Chuang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
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Household relationships and healthcare seeking behaviour for common childhood illnesses in sub-Saharan Africa: a cross-national mixed effects analysis. BMC Health Serv Res 2019; 19:308. [PMID: 31088474 PMCID: PMC6518738 DOI: 10.1186/s12913-019-4142-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background Intra-household dynamics play crucial roles in utilisation of healthcare services for children. We investigated the influence of household relationships on healthcare seeking behaviour for common childhood illnesses in four sub-Sahara African regions. Methods Data on 247,061 under-five children were extracted from recent Demographic and Health Surveys conducted between 2012 and 2016 in 25 countries. Data were combined and analysed per sub-region. Dependent variables (DVs) were uptake of health facility care for diarrhea and Acute Respiratory Tract Infection (ARI) symptoms. The main independent variable (IV) was household relationship which was represented by maternal marital profile (marital status, family type and number of marriages) and maternal relationship to household head. Mixed effects logit models were fitted to assess independent relationship between the IVs and DVs with adjustment for relevant demographic and socio-economic characteristics at 5% significance level. Results The percentage of children who received care for diarrhea and ARI symptoms from health facilities across sub-regions was: Western Africa (WA) 42.4, 44.1%; Central Africa (CA) 32.6, 33.9%; Eastern Africa (EA) 41.5, 48.7% and Southern Africa (SA) 58.9, 62.7%. Maternal marital profile was not associated with healthcare seeking behaviour for diarrhea and ARI symptoms in any of the sub-regions. Children whose mothers were daughter/daughter-in-law to household head were significantly less likely to be taken to health facility for diarrhea treatment in Eastern Africa (AOR = 0.81, CI: 0.51–0.95). Having a mother who is the head of household was significantly associated with higher odds of facility care for ARI symptoms for children from Western (AOR = 1.20, CI: 1.02–1.43) and Southern Africa (AOR = 1.49, CI: 1.20–1.85). Conclusion The type of relationship between mother of under-fives and head of households affect health seeking behaviour for treatment of diarrhea and ARI symptoms in Eastern, Western and Southern Africa. Countries in these regions need to adapt best practices for promoting healthcare utilisation for children such that household relationship does not constitute barriers. Electronic supplementary material The online version of this article (10.1186/s12913-019-4142-x) contains supplementary material, which is available to authorized users.
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Individual and community level factors associated with health facility delivery: A cross sectional multilevel analysis in Bangladesh. PLoS One 2019; 14:e0211113. [PMID: 30759099 PMCID: PMC6373895 DOI: 10.1371/journal.pone.0211113] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/08/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Improving maternal health remains one of the targets of sustainable development goals. A maternal death can occur at any time during pregnancy, but delivery is by far the most dangerous time for both the woman and her baby. Delivery at a health facility can avoid most maternal deaths occurring from preventable obstetric complications. The influence of both individual and community factors is critical to the use of health facility delivery services. In this study, we aim to examine the role of individual and community factors associated with health facility-based delivery in Bangladesh. Methods This cross-sectional study used data from the Bangladesh Maternal Mortality Survey. The sample size constitutes of 28,032 women who had delivered within five years preceding the survey. We fitted logistic random effects regression models with the community as a random effect to assess the influence of individual and community level factors on use of health facility delivery services. Results Our study observed substantial amount of variation at the community level. About 28.6% of the total variance in health facility delivery could be attributed to the differences across the community. At community level, place of residence (AOR 1.48; 95% CI 1.35–1.64), concentration of poverty (AOR 1.15; 95% CI 1.03–1.28), concentration of use of antenatal care services (AOR 1.11, 95% CI 1.00–1.23), concentration of media exposure (AOR 1.20, 95% CI 1.07–1.34) and concentration of educated women (AOR 1.12, 95% CI 1.02–1.23) were found to be significantly associated with health facility delivery. At individual level, maternal age, educational status of the mother, religion, parity, delivery complications, individual exposure to media, individual access to antenatal care and household socioeconomic status showed strong association with health facility-based delivery. Conclusion Our results strongly suggest factors at both Individual, and community level influenced the use of health facility delivery services in Bangladesh. Thus, any future strategy to improve maternal health in Bangladesh must consider community contexts and undertake multi-sectorial approach to address barriers at different levels. At the individual level the programs should also focus on the need of the young mother, the multiparous the less educated and women in the poorest households.
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Nkoka O, Chuang TW, Chuang KY, Chen YH. Factors associated with insecticide-treated net usage among women of childbearing age in Malawi: a multilevel analysis. Malar J 2018; 17:372. [PMID: 30340640 PMCID: PMC6195758 DOI: 10.1186/s12936-018-2522-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/09/2018] [Indexed: 12/19/2022] Open
Abstract
Background This study aimed to identify factors at individual and community level influencing insecticide-treated net (ITN) usage among groups of women of childbearing age (WOCBA) in Malawi. Methods Factors influencing ITN usage in Malawi were assessed through interviews with 16,130 WOCBA (15–49 years) across 850 communities who participated in the 2015–2016 Malawi Demographic Health Survey. Multilevel logistic regression analysis was used. Results ITN use was similar between pregnant women and non-pregnant women with children under 5 years (45.9% and 46.9%, respectively), but slightly lower among non-pregnant women without children under 5 years (39.1%). Both individual and community characteristics were associated with ITN use among WOCBA and varied significantly across subgroups. Specifically, non-pregnant women with children under 5 years living in communities where women had high autonomy in health care decisions had an 18% greater odds of using an ITN compared with those from communities where women had low health care autonomy (adjusted odds ratio [aOR] = 1.18; 95% confidence interval [CI] 1.00–1.38). Distance to health care facility influenced ITN usage among pregnant women; those who did not regard distance as a problem had a 44% greater odds of using an ITN than those for whom distance was seen as a problem (aOR = 1.44; 95% CI 1.09–1.89). Number of household members, region, urbanization, and community ITN coverage influenced ITN usage across all WOCBA groups. Conclusion The findings confirmed the importance of assessing various factors affecting ITN usage among groups of WOCBA. Both individual- and community-level factors should be considered when designing and implementing ITN programmes in Malawi.
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Affiliation(s)
- Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, 250 Wu-Hsing St., Taipei, 110, Taiwan
| | - Ting-Wu Chuang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kun-Yang Chuang
- School of Public Health, College of Public Health, Taipei Medical University, 250 Wu-Hsing St., Taipei, 110, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, 250 Wu-Hsing St., Taipei, 110, Taiwan.
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Koulidiati JL, De Allegri M, Souares A, Ouedraogo S, Hien H, Robyn PJ, Brenner S. Factors associated with effective coverage of child health services in Burkina Faso. Trop Med Int Health 2018; 23:1188-1199. [DOI: 10.1111/tmi.13140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Aurelia Souares
- Institute of Public Health; Heidelberg University; Heidelberg Germany
| | | | - Hervé Hien
- Centre Muraz; Bobo-Dioulasso Burkina Faso
- Institut de recherche en science de la santé; Bobo-Dioulasso Burkina Faso
| | | | - Stephan Brenner
- Institute of Public Health; Heidelberg University; Heidelberg Germany
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Gallay J, Pothin E, Mosha D, Lutahakana E, Mazuguni F, Zuakulu M, Decosterd LA, Genton B. Predictors of residual antimalarial drugs in the blood in community surveys in Tanzania. PLoS One 2018; 13:e0202745. [PMID: 30192770 PMCID: PMC6128528 DOI: 10.1371/journal.pone.0202745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/08/2018] [Indexed: 01/09/2023] Open
Abstract
Background Understanding pattern of antimalarials use at large scale helps ensuring appropriate use of treatments and preventing the spread of resistant parasites. We estimated the proportion of individuals in community surveys with residual antimalarials in their blood and identified the factors associated with the presence of the most commonly detected drugs, lumefantrine and/or desbutyl-lumefantrine (LF/DLF) or sulfadoxine-pyrimethamine (SP). Methods A cross-sectional survey was conducted in 2015 in three regions of Tanzania with different levels of malaria endemicity. Interviews were conducted and blood samples collected through household surveys for further antimalarial measurements using liquid chromatography coupled to tandem mass spectrometry. In addition, diagnosis and treatment availability was investigated through outlet surveys. Multilevel mixed effects logistic regression models were used to estimate odds ratios for having LF/DLF or SP in the blood. Results Amongst 6391 participants, 12.4% (792/6391) had LF/DLF and 8.0% (510/6391) SP in the blood. Factors associated with higher odds of detecting LF/DLF in the blood included fever in the previous two weeks (OR = 2.6, p<0.001), living in districts of higher malaria prevalence (OR = 1.5, p<0.001) and living in a ward in which all visited drug stores had artemisinin-based combination therapies in stocks (OR = 2.7, p = 0.020). Participants in older age groups were less likely to have LF/DLF in the blood (OR = 0.9, p<0.001). Factors associated with higher odds of having SP in the blood included being pregnant (OR = 4.6, p<0.001), living in Mwanza (OR = 3.9, p<0.001 compared to Mbeya), fever in the previous two weeks (OR = 1.7, p<0.001) and belonging to older age groups (OR = 1.2, p<0.001). Conclusion The most significant predictors identified were expected. History of fever in the past two weeks and young age were significant predictors of LF/DLF in the blood, which is encouraging. Antimalarial drug pressure was high and hence the use of recommended first-line drugs in combination with malaria Rapid Diagnostics Tests should be promoted to ensure appropriate treatment.
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Affiliation(s)
- Joanna Gallay
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Service and Laboratory of Clinical Pharmacology, University Hospital, Lausanne, Switzerland
- * E-mail:
| | - Emilie Pothin
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | | | | | - Blaise Genton
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Department of Community Health, University Hospital, Lausanne, Switzerland
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Tsukahara T, Sugahara T, Furusawa T, Hombhanje FW. Comparison of Health Service Utilization for Febrile Children Before and After Introduction of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy in Rural Papua New Guinea. Front Public Health 2018; 6:75. [PMID: 29594096 PMCID: PMC5859013 DOI: 10.3389/fpubh.2018.00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/26/2018] [Indexed: 11/16/2022] Open
Abstract
Background In Papua New Guinea (PNG), a malaria treatment policy using rapid diagnostic tests (RDTs) plus artemisinin-based combination therapy (ACT) was widely introduced to rural communities in 2012. The objectives of the study were to evaluate the effect of this RDT/ACT introduction to a rural PNG population on health service utilization and to compare factors associated with health service utilization before and after the RDT/ACT introduction. Methods Household surveys with structured questionnaires were conducted before and after the introduction of RDT/ACT in a catchment area of a health center in East Sepik Province, PNG. We interviewed caregivers with children less than 15 years of age and collected data on fever episodes in the preceding 2 weeks. Using propensity score matching, febrile children before the introduction of RDT/ACT were matched to febrile children after the introduction. Then, the adjusted difference in the proportion of health service utilization [i.e., the average treatment effect (ATE) of the introduction of RDT/ACT on health service utilization] was estimated. We also employed a multilevel Poisson regression model to investigate factors influencing the use of health services. Results Of 4,690 children, 911 (19%) were reported to have a fever episode. The unadjusted proportion of health service utilization was 51.7 and 57.2% before and after the RDT/ACT introduction, respectively. After matching, no significant difference in the health service utilization was observed before and after the introduction of RDT/ACT (ATE: 0.063, 95% confidence interval −0.024 to 0.150). Multilevel regression analysis showed that the consistent factors associated with a higher utilization of health services were severe illness and being female. Conclusion The utilization of health services was not significantly different before and after the introduction of RDT/ACT. Villagers may have neither sufficient informations on the new protocol nor high acceptance of RDT/ACT. The observed gender bias in health service utilization could be due to female caregivers’ preferences toward girls.
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Affiliation(s)
- Takahiro Tsukahara
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan.,Graduate School of Economics, Hosei University, Tokyo, Japan
| | - Takuma Sugahara
- Graduate School of Economics, Hosei University, Tokyo, Japan
| | - Takuro Furusawa
- Department of Ecology and Environment, Graduate School of Asian and African Area Studies, Kyoto University, Kyoto, Japan
| | - Francis Wanak Hombhanje
- Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
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