Investigation and analysis of the health care seeking behaviour of caregivers of sick children in Xinjiang, China: a cross-sectional study

Abstract

BackgroundThe Integrated Management of Childhood Illness (IMCI) strategy aims to reduce death, illness, and disability, and to promote improved growth and development among children younger than 5 years, especially through making the best use of the available health-care resources. The IMCI strategy has been introduced in Xinjiang, China, by Save the Children since 2014. The health care seeking behaviour of caregivers of children who are sick is identified as the primary factor affecting the project implementation. We thus aimed to study factors that might influence health care seeking behaviour of caregivers in Xinjiang. MethodsWe did a cross-sectional study in Xinjiang using a socioeconomic questionnaire and semi-structured interview with questions about health care seeking behaviour and its influencing factors in Chinese and Uighur. We recruited caregivers of sick children younger than 5 years from villages in townships of the Moyu County, Xinjiang, as the targeted project sites, using a stratified random cluster sampling method. We excluded caregivers with mental disorders, communicable diseases, and severe organic disease (ie, patients who could not finish the interview). The primary measure was the type of health-care institution that caregivers of sick children chose. We used descriptive statistics and a linear regression analysis. Ethical approval was obtained from the Peking University Health Science Center Ethics Committee. All participants provided written informed consent. FindingsBetween Jan 29, 2018, and April 28, 2018, 945 caregivers were recruited from 69 villages in eight township of the Moyu County. 877 caregivers completed the questionnaires, yielding a response rate of 93%. Although the public village clinics were strongly encouraged by the IMCI strategy, 347 (40%) of 877 caregivers regarded private clinics as their first choice, 299 (34%) chose the township health centres, and only 95 (11%) chose public village clinics. The cost (odds ratio [OR] 2·59, 95% CI 1·74–3·86; p<0·0001), distance (2·19, 1·55–3·10; p=0·0009), and attitudes of the medical staffs (1·46, 1·02–2·07; p=0·037) were considered as the facilitators that promote caregivers to choose the public village clinics, whereas the traditional values on health care seeking behaviour (OR 0·50, 95% CI 0·27–0·91; p=0·023) and inadequate medicines (0·33, 0·19–0·58; p=0·0004) were considered as the hindrances that impede caregivers to choose the public village clinics. InterpretationThe health care seeking behaviour of the caregivers of the children who are sick were not as expected compared with what the IMCI recommended. More attention needs to be given on the issue of the local culture's health care seeking behaviour. Besides enhancing the village doctors' competencies, adequate numbers and types of medicines are very important, which is also the key point of the strategies to promote children's health in the rural areas of Xinjiang and western China. FundingSave the Children (number CTXJ-2018-0148).