Abstract
BackgroundDespite investments in providing free government health services in Uganda, many caretakers still seek treatment from the drug shops/private clinics. The study aimed to assess determinants for use of government facilities or drug shops/private clinics for febrile illnesses in children under five.MethodsStructured questionnaires were administered to caretakers in 1078 randomly selected households in the Iganga – Mayuge Demographic Surveillance site. Those with children who had had fever in the previous two weeks and who had sought care from outside the home were interviewed on presenting symptoms and why they chose the provider they went to. Symptoms children presented with and reasons for seeking care from government facilities were compared with those of drug shops/private clinics.ResultsOf those who sought care outside the home, 62.7% (286/456) had first gone to drug shops/private clinics and 33.1% (151/456) first went to government facilities. Predictors of having gone to government facilities with a febrile child were child presenting with vomiting (OR 2.07; 95% CI 1.10 – 3.89) and perceiving that the health providers were qualified (OR 10.32; 95% CI 5.84 – 18.26) or experienced (OR 1.93; 95% CI 1.07 – 3.48). Those who took the febrile child to drug shops/private clinics did so because they were going there to get first aid (OR 0.20; 95% CI 0.08 – 0.52).ConclusionPrivate providers offer 'first aid' to caretakers with febrile children. Government financial assistance to health care providers should not stop at government facilities. Multi-faceted interventions in the private sector and implementation of community case management of febrile children through community medicine distributors could increase the proportion of children who access quality care promptly.
Highlights
Despite investments in providing free government health services in Uganda, many caretakers still seek treatment from the drug shops/private clinics
The health system in Uganda is arranged in a hierarchical system starting with the Health Centre I (HC I) at the village level which acts as an outpost for outreach services going up to the National Referral Hospitals with advanced tertiary care (Table 1)
In the remaining eight households, the children were not at home at the time the research team went there. Comparing those who had migrated with those we found at home, there was no significant difference with respect to household head education status and household socio-economic status
Summary
Despite investments in providing free government health services in Uganda, many caretakers still seek treatment from the drug shops/private clinics. The study aimed to assess determinants for use of government facilities or drug shops/private clinics for febrile illnesses in children under five. In Uganda, there is a high disease burden from febrile illnesses with malaria contributing 30 – 50% of outpatient burden and 35% of hospital admissions [3]. Those affected by malaria are mostly women and children under five years. In 2001, the government removed user fees from all the government health facilities except for the private wing in the district hospitals and there was a rapid increase in utilization of care [5]. Studies have demonstrated that even after removal of user fees quality of care was maintained [6]
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