Abstract
BackgroundAccess to child health services is an important determinant of child health. Whereas, child health indicators are generally better in urban than rural areas, some population groups in urban areas, such as children residing in urban slums do not enjoy this urban health advantage. In the context of increasing urbanisation and urban poverty manifesting with proliferation of urban slums, the health of under-five children in slum areas remains a public health imperative in Malawi. This paper explores healthcare-seeking practices for common childhood illnesses focusing on use of biomedical health services and perceived barriers to accessing under-five child health services in urban slums of Lilongwe, Malawi’s capital city.MethodsQualitative data from 8 focus group discussions with caregivers and 11 in-depth interviews with key informants conducted from September 2012 to April 2013 were analysed using conventional content analysis.ResultsWhereas, caregivers sought care from biomedical health providers, late care-seeking also emerged as a major theme and phenomenon. Home management was actively undertaken for childhood illnesses. Various health system barriers: lack of medicines and supplies; long waiting times; late facility opening times; negative attitude of health workers; suboptimal examination of the sick child; long distance to health facility; and cost of healthcare were cited in this qualitative inquiry as critical health system factors affecting healthcare-seeking for child health services.ConclusionsInterventions to strengthen the health system’s responsiveness to expectations are essential to promote utilisation of child health services among urban slum populations, and ultimately improve child health and survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1678-x) contains supplementary material, which is available to authorized users.
Highlights
Access to child health services is an important determinant of child health
The Malawi Millennium development goals (MDG) end line survey reports that the country has achieved its MDG four [1], which aspired to reduce under-five mortality rate by two-thirds by 2015 from the 1990 levels [2]
Findings of this study were important in defining health system attributes to be quantitatively explored in the larger study, with regard to their relative importance in influencing utilisation of child health services among urban slum care givers
Summary
Access to child health services is an important determinant of child health. Child health indicators are generally better in urban than rural areas, some population groups in urban areas, such as children residing in urban slums do not enjoy this urban health advantage. In the context of increasing urbanisation and urban poverty manifesting with proliferation of urban slums, the health of under-five children in slum areas remains a public health imperative in Malawi. The Millennium Development Goals (MDGs) significantly shaped global and national health policy content and child health discourse for the past decade. Child health indicators will show dismal improvements if the health of children in disadvantaged settings stagnates. To meaningfully improve child health indicators entails tremendous efforts to increase access to health services among the worse-off groups. The newly adopted Sustainable Development Goals succeeding the MDGs aspire for equitable and
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