Abstract
Developing effective context-specific strategies to ensure that a high proportion of children receive timely and appropriate care requires knowing the source from which care is sought. Although Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) collect such data in disaggregated form, they are not made available in the standard DHS and MICS reports. Secondary data analysis was done on 42 DHS and MICS surveys conducted since 2005 for care seeking for acute respiratory illness (DHS and MICS), diarrhea (DHS only), and fever (DHS only), disaggregating by urban-rural settings. Eight categories were used for source of care. Stata, version 12, was used for the analysis. Patterns varied considerably, with care seeking in most of sub-Saharan Africa predominantly from public-sector providers, in South Asia predominantly from the private sector, and in Southeast Asia from a mix of public and private sources. Community health workers were not an important source of care. Variation in care-seeking patterns has implications for effective strategy, as described in more detail in 5 country examples from Asia and Africa. The analysis also suggests that it may be inappropriate to focus program efforts on community health workers to the exclusion of more widely used sources of care. The authors argue that, in order to ensure sounder program approaches, disaggregated care-seeking data should be routinely included in DHS and MICS reports. Finally, the authors call for more data on actual care provided in order to improve quality of care.
Highlights
Developing effective context-specific strategies to ensure that a high proportion of children receive timely and appropriate care requires knowing the source from which care is sought
I n less-developed countries, pneumonia and diarrhea remain the leading causes of deaths among children beyond the newborn period; in many sub-Saharan African countries, they are joined by malaria as a major cause.[1]
This paper reports on a secondary analysis of standard Demographic and Health Surveys (DHS) surveys conducted in sub-Saharan Africa, South Asia, and Southeast Asia since 2005–2006, and of Multiple Indicator Cluster Surveys (MICS) surveys conducted over the period 2005–2008, providing a disaggregated picture of care seeking for cough, fever, and diarrhea
Summary
Developing effective context-specific strategies to ensure that a high proportion of children receive timely and appropriate care requires knowing the source from which care is sought. In order to develop child survival strategies that effectively address the need for treatment of potentially life-threatening childhood illness, program managers need to understand the populations they work with. It is to those developing and managing child health programs, at the country level, that this paper is primarily directed.
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