Abstract
BackgroundEthiopia has experienced rapid improvements in its healthcare infrastructure, such as through the recent scale up of integrated community case management (iCCM) delivered by community-based health extension workers (HEWs) targeting children under the age of five. Despite notable improvements in child outcomes, the use of HEWs delivering iCCM remains very low. The aim of our study was to explain this phenomenon by examining care-seeking practices and treatment for sick children in two rural districts in the Oromia Region of Ethiopia.MethodsUsing qualitative methods, we explored perceptions of child illness, influences on decision-making processes occurring over the course of a child’s illness and caregiver perceptions of available community-based sources of child illness care. Sixteen focus group discussions (FGDs) and 40 in-depth interviews (IDIs) were held with mothers of children under age five. For additional perspective, 16 IDIs were conducted fathers and 22 IDIs with health extension workers and community health volunteers.ResultsCaregivers often described the act of care-seeking for a sick child as a time of considerable uncertainty. In particular, mothers of sick children described the cultural, social and community-based resources available to minimize this uncertainty as well as constraints and strategies for accessing these resources in order to receive treatment for a sick child. The level of trust and familiarity were the most common dynamics noted as influencing care-seeking strategies; trust in biomedical and government providers was often low.ConclusionsOverall, our research highlights the multiple and dynamic influences on care-seeking for sick children in rural Ethiopia. An understanding of these influences is critical for the success of existing and future health interventions and continued improvement of child health in Ethiopia.
Highlights
Ethiopia has experienced rapid improvements in its healthcare infrastructure, such as through the recent scale up of integrated community case management delivered by community-based health extension workers (HEWs) targeting children under the age of five
Conceptualization of child illness For many participants in this study, child illness was seen as a deviation from an ideal state of joli si’a ina qaba (“child full of health/energy”)
According to several Focus group discussion (FGD) participants, traditional medicines, consisting of herbs and amulets given by the hand of a respected elder, are the correct treatment of lafu
Summary
Ethiopia has experienced rapid improvements in its healthcare infrastructure, such as through the recent scale up of integrated community case management (iCCM) delivered by community-based health extension workers (HEWs) targeting children under the age of five. Ethiopia has recorded notable progress in child health outcomes, including meeting the fourth Millennium Development Goal (MDG-4) target of reducing underfive child mortality by two-thirds since 1990 [1] Much of this success has been attributed to the rapid expansion of health care infrastructure, primary care coverage and scale up of community-based child health interventions to Ethiopia’s underserved and largely. Concerns such as cost and distance are limited in accounting for care-seeking choices [10] These studies often investigate the pathways at specific points (e.g., recognition of illness, decision to seek care, choice of care provider, etc.) over the course of a child illness episode [8, 11]. Focusing solely on the use of biomedical options limits the ability to understand the full range of care-seeking behaviors
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