The Impact of Socio-Economic Conditions and Clinical Characteristics on Improving Childhood Care Seeking Behaviors for Families Living far from the Health Facility

Abstract

Background: Lack of proper transportation and poor road infrastructure to the health facility act as a strong barrier for the adequate accessibility to healthcare services. There is lack of evidence based information particularly in Bangladesh examining the relationship between health care seeking behavior of mothers for their children with diarrhea and barriers such as distance to be travelled in reaching health facility. Objective: This study explored the factors that determine improving care seeking behaviors by the caregivers of under-5 children with diarrhea and also measured its impact due to living too far from a tertiary health facility in rural Bangladesh. Methodology: From January 2010 to December 2011, a total of 2,324 under-five children with diarrhea received treatment at Kumudini Womens’ Medical College and Hospital, Mirzapur, Tangail. Among them, 1,919 (83%) received treatment at home before coming to the health facility. Based on median value of 4 miles needed to travel, we divided distance into two groups: (i) >4 miles, (ii)≤4 miles. Results: Forty nine percent (n=1,144) of the diarrheal children presented to the facility from a distance of >4 miles and 86% of them received treatment at home before reporting to the hospital. Multivariate analysis revealed that age [aOR=0.72 (95% confidence interval;0.53, 0.99) p-value=0.042], longer distance [1.46 ( 1.15, 1.86) 0.002], onset of diarrhea (≥3days) [3.19 (2.37, 4.30) <0.001], stool frequency (>10 times/24 hours) [2.72 (2.05, 3.60) <0.001], presence of blood in stool [0.41 (0.31, 0.54) <0.001], vomiting [1.78 (1.38, 2.30) <0.001] and rotavirus infection [2.08 (1.49, 2.91) <0.001] were significantly associated with prior healthcare seeking behavior of children after controlling for other confounders. On the other hand, longer distance of the facility from home for children who received prior treatment was associated with children aged <2 years old [1.62 (1.26, 2.09) <0.001], electricity in the household [1.59 (1.23, 2.05) <0.001], vomiting [1.26 (1.03, 1.54) 0.028] and fever [1.42 (1.10, 1.83) 0.007] after adjusting for other co-variates. Conclusions: Longer distance of health facility delays seeking appropriate medical care from the facility rather parent seeks care from facilities to the next door of the locality. Clinical features such as fever, vomiting, and more stool frequency influence parents to get prior treatment before reporting to health facility, whether, presence of blood in stool influence parents in reporting directly to the health facility.