Abstract
BackgroundThe existence and magnitude of socio-economic inequalities in health-seeking behaviours for child curative care in Egypt and mechanisms underlying these associations have not been comprehensively assessed. This study examined whether socio-economic position (SEP) was associated with health-seeking behaviours for diarrhoea and acute respiratory infection (ARI) in children and explored potential mechanisms underlying these associations using mediation analysis.MethodsChildren aged under-five years living with their mothers sampled by the 2008 Egypt Demographic and Health Survey were used to estimate the prevalence of diarrhoea and ARI in the two-week period preceding the survey. If either illness was reported, three dimensions of health-seeking were examined in adjusted mediation models, separately by illness: whether medical care was sought, whether such care was timely (within one day of symptom onset), and whether it was sought from private providers. Latent variables of parental socio-cultural capital and household-level economic capital were the main exposures of interest.ResultsIn the sample of 10,006 children, 8.4 % had diarrhoea and 7.6 % had ARI. Care was sought for 62.0 % of children with diarrhoea and 78.5 % with ARI; two-thirds of care-seeking for both illnesses was timely. More than 7 in 10 children who sought care were taken to private providers. Socio-cultural capital or economic capital were not independently associated with seeking care for either illness. Socio-cultural capital was positively associated with timely care-seeking, and economic capital was positively associated with private provider use in adjusted analyses for both illnesses.ConclusionsSEP was not a strong determinant of care-seeking for diarrhoea or ARI, but there was a modest positive effect of SEP on timely receipt of care and private provider use. Further research is needed to explore perceptions of illness severity and the availability and quality of care from public and private providers.
Highlights
The existence and magnitude of socio-economic inequalities in health-seeking behaviours for child curative care in Egypt and mechanisms underlying these associations have not been comprehensively assessed
This study used the 2008 Egypt Demographic and Health Survey (DHS) to address three objectives. It described the prevalence of diarrhoea and acute respiratory infection (ARI) reported for children under-five years of age living in Egypt
Study sample The analysis was based on the 2008 Egypt DHS, a nationally-representative survey of households that collected indicators of child health for all children underfive born to all ever-married women aged 15–49 living in sampled households
Summary
The existence and magnitude of socio-economic inequalities in health-seeking behaviours for child curative care in Egypt and mechanisms underlying these associations have not been comprehensively assessed. This study examined whether socio-economic position (SEP) was associated with health-seeking behaviours for diarrhoea and acute respiratory infection (ARI) in children and explored potential mechanisms underlying these associations using mediation analysis. Mortality attributed to diarrhoea and pneumonia was estimated to account for 18 % of deaths among children under-five years in Egypt in 2010 [9]. A study employing verbal autopsy methods showed that diarrhoeal diseases and acute respiratory infection were the leading causes of mortality among children 1–4 years of age, accounting for more than 80 % of these deaths [10]. A better understanding of the determinants of health-seeking behaviours for curative care after the onset of these illnesses is crucial to developing strategies to further reduce under-five mortality
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