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

Delays in health care seeking for diarrheal disease and associated factors among caregivers of under five children in health centers of northwest Ethiopia: a mixed-method study

BACKGROUND

Approximately 70% of child deaths due to diarrhea are caused by a lack of timely healthcare. However, there was little evidence of factors associated with delays in seeking health care for patients with diarrheal diseases in the study area. Therefore, this study aimed to investigate delays in seeking healthcare for children with diarrhea and identify associated factors among caregivers in health centers of Northwest Ethiopia.

METHOD AND MATERIALS

An institution-based mixed study method was conducted from May to June 2022. Quantitative data were collected from 374 participants who were selected by systematic random sampling using a structured interviewer-administered questionnaire and chart review. The data were analyzed using the Statistical Package for Social Science software version 25. Bivariable and multivariable logistic regression models were used to identify associated factors. Variables with a p- value < 0.05 in the multivariable analysis were considered to be significantly associated. Qualitative data were collected from participants in waiting area after receiving treatments via in-depth interviews and analyzed using open-source software. The qualitative data were transcribed, translated, coded, thematized, and interpreted accordingly.

RESULTS

In this study, 53.48% of patients experienced delays in seeking healthcare for diarrhea. A large family size (adjusted odds ratio (AOR) = 2.64, 95% CI: 1.26-5.4), poor knowledge about diarrhea danger signs (AOR = 3.25, 95% CI: 1.6-6.6), difficulty paying for treatment (AOR = 2.95, 95% CI: 1.6-5.3), not visiting health facilities as the first response to diarrhea (AOR = 3.94, 95% CI: 1.96-7.9), only diarrhea (AOR = 2.39, 95% CI: 1.01-5.63), and no information about early healthcare seeking (AOR = 4.88, 95% CI: 1.91-12.43) were identified; moreover, from the qualitative findings, mothers' perceptions of the illness were mild, poor service provision, and economic problems were determinants of delay. Awareness, barriers, compliance, and perception emerged as themes.

CONCLUSION

The prevalence of delays in seeking healthcare for children with diarrhea was high. This poses a negative health risk to the lives of children and their caregivers. A large family size, poor knowledge about diarrhea danger signs, difficulty paying for treatment, and many others were factors associated with delayed health care seeking. Hence, the government and other concerned stakeholders should give due emphasis to tackling the identified causes of delay in seeking health care for children under five years of age with diarrhea by diverting community focus toward timely care seeking and disease prevention.

Prevalence of diarrhoea and treatment-seeking practices among children <2 years of age in the Birhan cohort, Ethiopia, 2018-19

Background

Estimating the proportion of children with diarrhoea and those who are taken in as inpatients or outpatients is important for policy planning, resource allocation, and to evaluate the effectiveness of diarrhoea prevention and control interventions. We aimed to estimate the proportion of children <2 years of age with diarrhoea, explore their treatment-seeking practices, and identify factors associated with both diarrhoea and treatment seeking.

Methods

We designed a longitudinal study based on a sample of children <2 years of age in the Birhan field site from September 2018 to September 2019. The study site collected data on child mortality and morbidity and treatment-seeking practice for those with a history of illness every three months. Mothers/caregivers were asked about signs or symptoms of illnesses for a two-week period prior to each study visit. We estimated the proportion of children <2 years of age with diarrhoea and treatment-seeking practices for each of the four rounds of data collection and identified associated factors through bivariable and multivariable logistic regression.

Results

We enrolled 4678 children <2 years of age. The proportion of children with diarrhoea was the highest from 11 September 2018 to 9 December 2018 (4.47%; 95% confidence interval (CI) = 3.70-5.35) and the lowest from 10 December 2018 to 9 March 2019 (2.48%; 95% CI = 1.90-3.19). Children from households with chlorinated drinking water had a 50% (adjusted odds ratio (aOR) = 0.50; 95% CI = 0.28-0.88) lower odds of developing diarrhoea compared to those who did not. Among 339 children with diarrhoea, 275 (81.12%; 95% CI = 76.54-85.15) were taken to health facilities for treatment. Female children had lower odds of being taken to health facilities for treatment (aOR = 0.37; 95% CI = 0.17-0.80) compared to males.

Conclusions

While the proportion of children with diarrhoea in our study was lower than that observed in prior research conducted in Ethiopia, treatment-seeking practices were higher. Female children and children from the poorest families had lower odds of treatment. We recommend more studies to explore gender-based and socioeconomic differences affecting treatment-seeking practices.

Healthcare-seeking behavior for diarrhea in under-five children and associated factors in sub-Saharan Africa: a multilevel robust Poisson regression model

Background

Diarrhea is one of the leading causes of child death in sub-Saharan Africa (SSA). Children with diarrhea who do not receive medical advice or treatment are at high risk of poor health outcomes and increased mortality. Prompt and adequate treatment is essential to mitigate these risks. However, studies that have been conducted on the factors influencing healthcare-seeking behavior (HSB) for diarrhea in under-five children in SSA are scarce. Therefore, the purpose of this research was to determine the variables related to HSB for diarrhea in children under the age of five.

Methods

A secondary data analysis was conducted on the most recent data from the Demographic and Health Surveys in 35 SSA countries. The study included a total weighted sample of 51,791 children under the age of five with diarrhea. We presented the adjusted prevalence ratio and the 95% confidence interval in the multivariable multilevel robust Poisson regression analysis to show the statistical significance and strength of the association between HSB and its determinants.

Results

The pooled prevalence of HSB for diarrhea in under-five children was 58.71% (95%CI: 55.39 to 62.04). Factors found to be associated with HSB included maternal age, education and working status, antenatal care visits, postnatal checkups for the child, wasting, distance to a health facility, SSA region, and country income level.

Conclusion

More than 40% of under-five children with diarrhea in SSA did not receive medical advice or treatment. To improve healthcare-seeking behavior, effective health policy interventions are necessary. These include enhancing the education and employment status of mothers, promoting regular antenatal and postnatal care visits, building health facilities in close proximity, and raising awareness in the community about the importance of seeking healthcare services for malnourished children.

Etiological surveillance of viral diarrhea from 2017 to 2019 in Zhangzhou city, Fujian province, China

Background

Viral diarrhea is one of the major causes of morbidity and mortality in children. This study aimed to conduct etiological surveillance of viral diarrhea in Zhangzhou city, Fujian province, China, from 2017 to 2019 to identify the prevalence, distribution, and characteristics of viral pathogens causing gastrointestinal infections in the region.

Methods

Stool samples were collected from patients with acute diarrhea in Zhangzhou city, Fujian province, China, from 2017 to 2019. Rotavirus, norovirus, astrovirus, and adenovirus were detected using fluorescence immunochromatography assay.

Results

Of the total 5,627 samples that were collected, at least one of the viruses (rotavirus, norovirus, astrovirus and adenovirus) was found to be positive in 1,422 samples. Rotavirus, norovirus, astrovirus, and adenovirus, were detected in 53.73, 16.68, 15.52, and 14.97%, respectively. Mixed infections were determined in 17.65% of the positive samples. The predominant mixed infections observed were a combination of norovirus and astrovirus, followed by rotavirus and norovirus, and rotavirus and astrovirus. The highest positive rate was observed in the 12-23-month group for rotavirus and adenovirus, while a significantly higher positive rate was observed for norovirus and astrovirus in the 6-11-month group.

Conclusion

These findings from this etiological surveillance highlight the significant burden of viral diarrhea in Zhangzhou city, with rotavirus being the predominant pathogen. The identification of common mixed infections provides insights into the complex nature of viral diarrhea transmission. Target interventions and public health strategies should be implemented, particularly during the winter and spring seasons, to prevent and control the spread of viral pathogens causing gastrointestinal infections in this region.

Reasons, experiences and expectations of women with delayed medical care for ectopic pregnancies in Chinese urban edges: a qualitative study

OBJECTIVE

To explore the experiences of patients with ectopic pregnancies with delayed medical care, with the goals to promote timely access to care, reduce subsequent physical and psychological impacts, and provide recommendations for improved management of ectopic pregnancies.

DESIGN

A qualitative study.

SETTING

A 1000-bed urban edge hospital located in the suburban area of Guangzhou, China, between December 2022 and February 2023.

PARTICIPANTS

21 patients with delays in seeking medical care for ectopic pregnancy.

PRIMARY AND SECONDARY OUTCOME MEASURES

Semistructured, in-depth, face-to-face interviews were conducted to understand the experience and expectations of these women.

RESULTS

Three main themes emerged, including delaying medical care, physical and psychological experiences, and expectations of their healthcare providers. Each of these main themes had several subthemes. The central theme of reasons for delaying medical care had five subthemes, including lack of knowledge on early symptoms of ectopic pregnancy, family dynamics and circumstances, traditional fertility ideology and intentions, avoidance of medical treatment behaviour, and medical delays. The main theme of physical and psychological experiences had two subthemes, including learnings from the experiences and negative impacts of the experiences. The main theme of expectations of their healthcare providers included three subthemes that were reducing the length of outpatient examinations and waiting times, increasing public understanding of early symptoms of ectopic pregnancy and increasing male awareness of safe contraceptive methods.

CONCLUSIONS

A lack of knowledge about the early symptoms of ectopic pregnancy was the main reason for delays in seeking medical care and had a dual impact on patients' physical and mental health, affecting their recovery and future healthcare. A collective effort from patients, families, healthcare providers and medical institutions is required for better medical education, family support, specialised professional training and local fertility policy to decrease the incidence of delayed medical care and achieve satisfactory pregnancy outcomes.

Parasitic etiology of diarrhea and associated factors among under-five-year children attending Mizan-Tepi University Teaching Hospital, Southwest Ethiopia

Introduction

globally, an estimated two billion cases of diarrhea occur every year, and an estimated 1.7 million children under the age of five years, mostly in developing countries die due to diarrheal cases. It is caused by different enteropathogens such as bacteria, viruses, and parasites. Diarrhea caused by parasitic etiology is common in under-five-year children in sub-Saharan Africa. The objective was to investigate the parasitic etiology of diarrhea among under-five-year children in Mizan-Tepi University Teaching Hospital, Southwest Ethiopia.

Methods

institution-based cross-sectional study was conducted from September to November 2021. A total of 300 under-five-year children presenting with diarrhea in Mizan-Tepi University Teaching Hospital were included in the study. Data used to assess associated factors for intestinal parasitic infections (IPIs) was collected using a structured questionnaire. Stool specimens were collected from the study participants for investigations of the parasitic etiology of diarrhea. The specimens were processed microscopically using direct wet mount and formol ether concentration techniques. Modified Ziehl-Neelsen staining of formol-ether concentrated specimens was also performed. Data was entered using Epi-Data version 4.6.0 and analyzed using Stata/SE version 14.0. Crude odds ratio and adjusted odds ratio were used to determine the association.

Results

from a total of 300 children who participated in this study, 68 (22.67%) were positive for at least one intestinal parasite. E. histolytica23(7.67%) and G. lamblia17(5.67%) were the predominant parasitic etiologies and 28(9.33%) were positive for intestinal helminthic parasites; 11(3.67%) Ascaris lumbricoides, 10(3.33%) Trichuris trichiura, 4(1.33%) Hymenolepsis nana, and 3(1%) were double infection with Trichuris trichuria and Ascaris lumbricoides. Multivariable analysis revealed the age group category 2-3 years of age children was more attributable to intestinal parasitic infections (AOR= 0.466, 95% CI: 0.204-0.976).

Conclusion

the overall prevalence of intestinal parasitic infections (IPIs) in this study was 22.67%. Diarrheal etiology of intestinal parasites among under five years of children identified in this study were significantly associated with maternal/ guardians´ educational status, (AOR=94.900, 95% CI: 24.664-365.155) use of unprotected water for drinking, (AOR =25.189, 95% CI: 4.671-135.847).

Contributing factors of delay in seeking treatment for childhood diarrheal diseases in Berbere Woreda, Ethiopia: an unmatched case-control study

BACKGROUND

A major cause of diarrheal illness mortality is a failure to seek immediate medical assistance. There is currently no evidence on the reasons that induce caregivers in Berbere Woreda to delayed seeking timely treatment for under-five children with diarrheal illnesses. As a result, the goal of this study was to identify determinants of delay in seeking timely treatment for childhood diarrheal diseases in Berbere Woreda, Bale Zone Oromia Region, South Eastern Ethiopia.

METHODS

An unmatched case-control study on 418 child caregivers was conducted from April to May 2021. Cases were 209 children and their caregivers who sought treatment after 24 h of the onset of diarrheal disease symptoms, and controls were 209 children and their mothers/caregivers who sought treatment within 24 h of the onset of diarrheal disease symptoms. Data were collected through interviews and chart reviews using consecutive sampling. A multivariable logistic regression analysis was carried out, with variables with a P-value of 0.05 considered statistically significant. The Hosmer-Lemshow goodness of fit test was used to validate the model, and the variance inflation factor (VIF) was used to test for multi-collinearity.

RESULTS

In this study, we found that among 418 participants, determinants of delay in seeking timely treatment for childhood diarrheal diseases included mothers with more than two under-five children (AOR = 2.23, 95% CI 1.21-4.11), Divorce (AOR = 2.62, 95% CI 1.087-2.76), age of children < 24 months (AOR = 1.597, 95%,CI (1.008-2.531), and preference for a government health facility for treatment (AOR = 2.56, 95% CI 1.51-4.34). Besides, the odds of mothers aged 25-34 years being two times more likely to delay seeking timely treatment for 5 children with diarrhea were 1.537 (0.560-4.213).

CONCLUSIONS

Age of children, age of mothers, number of children, preference of health facilities, and marital status were factors influencing the failure to seek treatment within 24 h of recognizing diarrhea in children under the age of five.

Causes of infant deaths and patterns of associated factors in Eastern Ethiopia: Results of verbal autopsy (InterVA-4) study

Background

In a range of setting, detecting and generate empirical information on the cause of infant death and contributing risk factors at population level is basically utmost essential to take evidence-based measures in reducing infant morbidity and mortality. An electronic verbal autopsy is suitable tool and best alternative solution to determine individuals’ cause of death in a setting where the majority of deaths occur at home and civil registration systems do not exist. The present study was undertaken to find out cause of infant death, applying computer-based probabilistic model (InterVA-4) and analyze the patterns of association factors of mother’s and the deceased infant’s characteristics to the leading cause-specific infant mortality in Eastern Ethiopia.

Methods

The study employed a community-based prospective longitudinal survey, which was conducted with routinely enumeration of reported infant deaths for a period of two years (from September 2016 to August 2018) in Eastern part of Ethiopia. Using the two-stage cluster sampling technique, the study was undertaken in four randomly selected districts of West Hararghe zone and two districts of zone 3 in Oromia and Afar regional state, respectively. The study included a total of 362 infants who were deceased during the study period. Data was collected by trained enumerators by interviewing the mothers or guardians of the deceased infant using a 2014 standardize World Health Organization (WHO) Verbal Autopsy questionnaire. InterVA-4 model were used for processing and interpreting verbal autopsy data in order to arrive at the most likely causes of infant death. SPSS version 23 was also used for statistical analysis of frequency distribution and logistic regression for the association between covariates and outcomes.

Findings

Of the overall (362) deceased infants’ during the study period, 53.0% of deaths occurred during neonatal time while 47.0% died in the post-neonatal period. Acute respiratory infection including neonatal and post-neonatal pneumonia (38.4%), birth asphyxia (16.4%), diarrheal diseases (16.3%), prematurity (7.4%) and malaria (4.3%) were found to be the leading causes of infant mortality in the study area. The independent factors strongly associated with probable ARI, including pneumonia related mortality as compared to all-causes of death were infants with maternal age lower than 20 years old (p = 0.001, AOR: 4.82, 95% CI: 1.88, 12.3) and infant being died outside of heath facilities (P = 0.007, AOR: 2.85, 95% CI: 1.33, 6.12). The post-neonatal period (P = 0.000, AOR: 15.5, 95% CI: 6.35, 37.8) and infant died in the wet season (P = 0.006, AOR: 2.38, 95% CI: 1.28, 4.44) had strong relationship with dying from diarrhea-related death than those infants died from all non-diarrhea. The death due to malaria robustly associated with infants whose mothers age between 20–35 years old (P = 0.024, AOR: 4.44, 95% CI: 1.22, 16.2) and infant who was dwelled in the districts of Afar region (P = 0.013, AOR: 4.08, 95% CI: 1.35, 12.4).

Conclusion

The highest cause of infant mortality was associated with disease of respiratory system, particularly acute respiratory infection, including both neonates and post-neonatal pneumonia. Most of the infant deaths existed are as a result of diseases and conditions that are readily preventable or treatable cause, similar to those reported in worldwide, which have needs of further attention. The patterns of significant associated factors across cause-specific mortality against all-cause of death were dissimilar. Therefore, strengthen maternal and child health program with effective preventive interventions emphasizing on the most common cause of infant deaths and those factors contributing in raising mortality risk are required.

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

Objective

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

Methods

Literature searches were conducted through databases (Google Scholar, PubMed, CINHAL, ScienceDirect, HINARI, and gray literatures) from September 1 to 30, 2021, using key terms in accordance with the PRISMA guidelines. The characteristics of the original articles were described using text and tables. Heterogeneity among the reported prevalence of studies was checked by using a heterogeneity χ 2 test and I2 test. Publication bias was examined by performing Egger's correlation and Begg's regression intercept tests at a 5% significant level. A random-effect model was employed to estimate the pooled prevalence of the outcome variable and its determinants in Ethiopia.

Results

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

Conclusion

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