Care-seeking For Childhood Illnesses Research Articles

Care seeking for childhood illnesses in rural Mtwara, south-east Tanzania: a mixed methods study.

Care seeking was assessed in preparation for a study of the health impact of novel design houses in rural Mtwara, Tanzania. A total of 578 residents of 60 villages participated in this mixed-methods study from April to August 2020. Among them, 550 participated in a healthcare-seeking survey, 17 in in-depth interviews and 28 in key informant interviews. The decision to seek care was based on symptom severity (95.4% [370]). Caregivers first visited non-allopathic healthcare providers or were treated at home, which led to delays in seeking care at healthcare facilities. More than one-third (36.0% [140]) of respondents took >12 h seeking care at healthcare facilities. The majority (73.0% [282]) visited healthcare facilities, whereas around one-fifth (21.0% [80]) sought care at drug stores. Treatment costs deterred respondents from visiting healthcare facilities (61.4% [338]). Only 10 (3.6%) of the households surveyed reported that they were covered by health insurance. Quality of care, related to institutional factors, impacts timely care seeking for childhood illnesses in Mtwara, Tanzania. Ensuring accessibility of facilities is therefore not sufficient.

Determinants of inequality in health care seeking for childhood illnesses: insights from Nairobi informal settlements

BackgroundAn in-depth understanding of patterns of inequities in healthcare seeking among the urban residents is critical in identifying appropriate interventions strategies. The study evaluates determinants of inequality in health care seeking for childhood illnesses among informal settlement residents in Nairobi, Kenya. MethodsData from the second Nairobi Cross-Sectional Slum Survey (NCSS 2012) was examined. The inequality in seeking health care for childhood diarrhea as the prototype illness was assessed using concentration index (CI). The wealth index based on the household possessions and amenities was used as a measure for socioeconomic status. ResultsA total of 2 027 qualified women were included in this study. About 16.6% of children born of younger mothers aged < 20 years had diarrhea and a similar proportion of children (16.3%) was observed among mothers who were unemployed. The CI of −0.026 on health care seeking for diarrhea among children points to significant inequality among the urban poor (95% confidence interval: −0.028 to −0.023). ConclusionOccupation of parents, age of mothers, ethnicity, marital status and children's age were major determinants with regard to disease outcome and to a broader extent inequality in health care seeking for childhood illnesses. Enhanced bottom top community health invigoration strategies in health information awareness and services access would be instrumental.

Determinants of care-seeking behaviour for fever, acute respiratory infection and diarrhoea among children under five in Nigeria

BackgroundDespite available, inexpensive and effective treatments, malaria, diarrhoea, and pneumonia still contribute the majority of the global burden of childhood morbidity and mortality. Nigeria has the highest absolute numbers of child deaths worldwide. Appropriate care-seeking is important for prompt diagnosis, appropriate and timely treatment, and prevention of complications. The objective of this cross-sectional study was to examine the prevalence of and factors associated with appropriate care-seeking for childhood illnesses.MethodsWe used the most recent Nigeria Demographic and Health Survey (2018) to assess the prevalence of appropriate care-seeking among mothers of children under five with symptoms of common childhood illnesses. For diarrhoea, we defined appropriate care-seeking as seeking care from a formal health provider. For fever and acute respiratory infection (ARI), appropriate care-seeking was defined as seeking care from a formal provider the day of or after symptom onset. Multivariate logistic regression was carried out to assess factors associated with optimal care-seeking for each illness.ResultsAt least 25% of parents did not seek any care for children with fever or ARI; this figure was over one third for diarrhoea. Only 15% and 13% of caregivers showed appropriate care-seeking for their children with fever and ARI respectively, and 27% of mothers sought care from a formal provider for diarrhoea. Predictors of appropriate care-seeking varied according to childhood illness. Previous facility delivery was the only risk factor associated with increased odds of appropriate care-seeking for all three illnesses; other risk factors varied between illnesses.ConclusionOverall, care-seeking for childhood illnesses was suboptimal among caregivers in Nigeria. Interventions to increase caregivers’ awareness of the importance of appropriate care-seeking are needed alongside quality of care interventions that reinforce people’s trust in formal health facilities, to improve timely care-seeking and ultimately reduce the high burden of child deaths in Nigeria.

The effect of electronic job aid assisted one-to-one counselling to support exclusive breastfeeding among 0-5-month-old infants in rural Bangladesh.

Exclusive breastfeeding (EBF) for the first 6 months has established benefits, yet had slow improvements globally. Little is known about electronic job aid‐assisted counselling to support EBF. As a secondary outcome of a cluster randomized controlled trial in Bangladesh, we assessed the effect of electronic job aid‐supported nutrition counselling and practical demonstration on EBF. We randomized pregnant women to one of five study arms in the trial and followed mother–child dyads until 2 years of age. Community health workers (CHWs) provided breastfeeding counselling with or without prenatal and complementary nutrient supplements in all four intervention arms. The comparison arm continued with the usual practice where mothers could receive nutrition counselling at routine antenatal and postnatal care, and during careseeking for childhood illnesses. We assessed breastfeeding indicators at birth and monthly until the child was 6 months old, in both intervention and comparison arms. To evaluate the effect of nutrition counselling on breastfeeding, we combined all four intervention arms and compared them with the comparison arm. Intervention newborns had half the risk (relative risk [RR]: 0.54, 95% confidence interval [CI]: 0.39, 0.76) of receiving prelacteal feeds than those in the comparison arm. EBF declined steeply in the comparison arm after 3 months of age. EBF was 16% higher in the intervention than the comparison arm at 4 months (RR: 1.16, 95% CI: 1.08, 1.23) and 22% higher at 5 months of age (RR: 1.22, 95% CI: 1.12, 1.33). Maternal background and household characteristics did not modify the intervention effect, and we observed no difference in EBF among caesarean versus vaginal births. Breastfeeding counselling and practical demonstration using an electronic job aid by CHWs are promising interventions to improve EBF and are scalable into existing community‐based programmes.

Health postservice readiness and use of preventive and curative services for suspected childhood pneumonia in Ethiopia: a cross-sectional study

ObjectivePneumonia is the single-leading cause of infectious disease deaths in children under-5. Despite this challenge, the utilisation of preventive and curative child health services remains low in Ethiopia. We investigated...

A study on the morbidity profile of children under 5 years of age and knowledge of parents regarding their health seeking behavior

To study the morbidity profile of children under 5 years of age and knowledge of parents regarding their health seeking behavior. The study was a community based cross-sectional study. The study was conducted in the Field practice area of Rural Health Training Centre (RHTC) of Hind Institute of Medical Sciences, Barabanki. Families with at least one under five-year child, all family willing to participate and consenting and families residing in the study site for the minimum last 1 year were included in the study. A total of 400 subjects were included in the study. Door to door visit was done for data collection. Morbidity was almost nil in 0-2 months preceding the interview. Diarrhoea was most common morbidity during 2 months – 5 years preceding the interview. Government hospital for treatment was preferred by 53.5% of the respondents. Treatment at government hospital was taken by 55% of the respondents. Secondary level of care was available in 50.2% of the respondents. Only 2.2% of the respondents reported any problem with the treatment. Hospital was visited by 65% of the respondents for the treatment. Child’s last illness was 3-6 months in 52.8% of the respondents and Diarrhoea was the most common type of illness. 62.8% of the respondents visited government hospital for the treatment of child. More than one third of respondents visited health facility by bicycle (42.8%) and 24.5% approached by walking. Time taken to reach health facility was 15-30 minutes in 51% of the respondents. The main reason to choose particular health facility was Trust over the provider of the facility (41.5%). This study demonstrates the importance of maternal perception of illness severity in determining facility based care seeking for childhood illness in rural area.

Distance to primary care facilities and healthcare utilization for preschool children in rural northwestern Burkina Faso: results from a surveillance cohort

BackgroundDelays in care-seeking for childhood illness may lead to more severe outcomes. We evaluated whether community distance from a primary healthcare facility was associated with decreased healthcare utilization in a rural district of northwestern Burkina Faso.MethodsWe conducted passive surveillance of all government-run primary healthcare facilities in Nouna District, Burkina Faso from March 1 through May 31, 2020. All healthcare visits for children under 5 years of age were recorded on a standardized form for sick children. We recorded the age, sex, and community of residence of the child as well as any diagnoses and treatments administered. We calculated healthcare utilization per 100 child-months by linking the aggregate number of visits at the community level to the community’s population of children under 5 months per a census that was conducted from August 2019 through February 2020. We calculated the distance between each community and its corresponding healthcare facility and assessed the relationship between distance and the rate of healthcare utilization.ResultsIn 226 study communities, 12,676 primary healthcare visits were recorded over the three-month period. The median distance between the community and primary healthcare facility was 5.0 km (IQR 2.6 to 6.9 km), and median number of healthcare visits per 100 child-months at the community level was 6.7 (IQR 3.7 to 12.3). The rate of primary healthcare visits declined with increasing distance from clinic (Spearman’s rho − 0.42, 95% CI − 0.54 to − 0.31, P < 0.0001). This relationship was similar for cause-specific clinic visits (including pneumonia, malaria, and diarrhea) and for antibiotic prescriptions.ConclusionsWe documented a distance decay effect between community distance from a primary healthcare facility and the rate of healthcare visits for children under 5. Decreasing distance-related barriers, for example by increasing the number of facilities or targeting outreach to more distant communities, may improve healthcare utilization for young children in similar settings.

Setting an implementation research agenda for Canadian investments in global maternal, newborn, child and adolescent health: a research prioritization exercise.

Improving global maternal, newborn, child and adolescent health (MNCAH) is a top development priority in Canada, as shown by the $6.35 billion in pledges toward the Muskoka Initiative since 2010. To guide Canadian research investments, we aimed to systematically identify a set of implementation research priorities for MNCAH in low- and middle-income countries. We adapted the Child Health and Nutrition Research Initiative method. We scanned the Child Health and Nutrition Research Initiative literature and extracted research questions pertaining to delivery of interventions, inviting Canadian experts on MNCAH to generate additional questions. The experts scored a combined list of 97 questions against 5 criteria: answerability, feasibility, deliverability, impact and effect on equity. These questions were ranked using a research priority score, and the average expert agreement score was calculated for each question. The overall research priority score ranged from 40.14 to 89.25, with a median of 71.84. The average expert agreement scores ranged from 0.51 to 0.82, with a median of 0.64. Highly-ranked research questions varied across the life course and focused on improving detection and care-seeking for childhood illnesses, overcoming barriers to intervention uptake and delivery, effectively implementing human resources and mobile technology, and increasing coverage among at-risk populations. Children were the most represented target population and most questions pertained to interventions delivered at the household or community level. Investing in implementation research is critical to achieving the Sustainable Development Goal of ensuring health and well-being for all. The proposed research agenda is expected to drive action and Canadian research investments to improve MNCAH.

Integrated Community Case Management of Childhood Illness: What Have We Learned?

The evaluations of integrated community case management (iCCM) of childhood illness in Ethiopia, Malawi, and Burkina Faso published in this issue provide important new information to guide program design and implementation. Recognizing that in most countries with a high burden of child mortality, access to health services is limited for many families and their children, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) identified iCCM as an effective evidence-based strategy to increase coverage of lifesaving interventions and reduce preventable child deaths.1 Few program evaluations of iCCM at scale exist.2 The reports therefore are unique and valuable. However, none of the three reports demonstrated the desired iCCM objectives of increasing care seeking for childhood illness and improved coverage of effective treatment interventions at the population level.

Effects of the integrated Community Case Management of Childhood Illness Strategy on Child Mortality in Ethiopia: A Cluster Randomized Trial.

We conducted a cluster randomized trial of the effects of the integrated community case management of childhood illness (iCCM) strategy on careseeking for and coverage of correct treatment of suspected pneumonia, diarrhea, and malaria, and mortality among children aged 2–59 months in 31 districts of the Oromia region of Ethiopia. We conducted baseline and endline coverage and mortality surveys approximately 2 years apart, and assessed program strength after about 1 year of implementation. Results showed strong iCCM implementation, with iCCM-trained workers providing generally good quality of care. However, few sick children were taken to iCCM providers (average 16 per month). Difference in differences analyses revealed that careseeking for childhood illness was low and similar in both study arms at baseline and endline, and increased only marginally in intervention (22.9–25.7%) and comparison (23.3–29.3%) areas over the study period (P = 0.77). Mortality declined at similar rates in both study arms. Ethiopia's iCCM program did not generate levels of demand and utilization sufficient to achieve significant increases in intervention coverage and a resulting acceleration in reductions in child mortality. This evaluation has allowed Ethiopia to strengthen its strategic approaches to increasing population demand and use of iCCM services.

Independent Evaluation of the integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design.

We evaluated the impact of integrated community case management of childhood illness (iCCM) on careseeking for childhood illness and child mortality in Malawi, using a National Evaluation Platform dose-response design with 27 districts as units of analysis. “Dose” variables included density of iCCM providers, drug availability, and supervision, measured through a cross-sectional cellular telephone survey of all iCCM-trained providers. “Response” variables were changes between 2010 and 2014 in careseeking and mortality in children aged 2–59 months, measured through household surveys. iCCM implementation strength was not associated with changes in careseeking or mortality. There were fewer than one iCCM-ready provider per 1,000 under-five children per district. About 70% of sick children were taken outside the home for care in both 2010 and 2014. Careseeking from iCCM providers increased over time from about 2% to 10%; careseeking from other providers fell by a similar amount. Likely contributors to the failure to find impact include low density of iCCM providers, geographic targeting of iCCM to “hard-to-reach” areas although women did not identify distance from a provider as a barrier to health care, and displacement of facility careseeking by iCCM careseeking. This suggests that targeting iCCM solely based on geographic barriers may need to be reconsidered.

Health‐care‐seeking behaviour for childhood illnesses in a resource‐poor setting

To determine health-care-seeking behaviour for childhood illnesses in a resource-poor setting. Cross-sectional survey was conducted in the children emergency room in a Nigerian tertiary hospital. Socio-demographic data and details of the place and type of care given to ill children before presentation in the tertiary hospital were obtained. A total of 168 mother-child pairs were studied. The leading illnesses were characterised by fever (35.1%), cough (26.2%) and stooling (19.1%). Initial care was sought within homes (57.1%) and after 24 h of onset (61.9%). A significantly higher proportion of the mothers who sought care within 24 h did so within the homes (P < 0.001). Only 38.1% of the mothers felt that the illnesses were severe. Although 66.7% lived close to orthodox health facilities, only 50.6% utilized such orthodox health facilities. Care was mostly sought outside the homes from drug vendors (55.5%) and private clinics (25.0%). Overall, 72.2% of the mothers administered various drugs to their children before presentation. Home care mainly involved the use of drugs (52.1%) and herbal preparations (15.6%). Care was sought within 24 h of onset for children with fever compared with those with cough (P < 0.001) and stooling (P < 0.001). The leading reasons for not utilising orthodox health services at the onset of illnesses included non-recognition of the severe nature of the illness and poor finances. Care-seeking for childhood illnesses was often delayed beyond 24 h, and most mothers sought care within homes. Health education is required to improve timely seeking of appropriate health care for childhood illnesses.

Sex and socioeconomic differentials in child health in rural Bangladesh: findings from a baseline survey for evaluating Integrated Management of Childhood Illness.

This paper reports on a population-based sample survey of 2,289 children aged less than five years (under-five children) conducted in 2000 as a baseline for the Bangladesh component of the Multi-country Evaluation (MCE) of the Integrated Management of Childhood Illness strategy. Of interest were rates and differentials by sex and socioeconomic status for three aspects of child health in rural Bangladesh: morbidity and hospitalizations, including severity of illness; care-seeking for childhood illness; and home-care for illness. The survey was carried out among a population of about 380,000 in Matlab upazila (subdistrict). Generic MCE Household Survey tools were adapted, translated, and pretested. Trained interviewers conducted the survey in the study areas. In total, 2,289 under-five children were included in the survey. Results showed a very high prevalence of illness among Bangladeshi children, with over two-thirds reported to have had at least one illness during the two weeks preceding the survey. Most sick children in this population had multiple symptoms, suggesting that the use of the IMCI clinical guidelines will lead to improved quality of care. Contrary to expectations, there were no significant differences in the prevalence of illness either by sex or by socioeconomic status. About one-third of the children with a reported illness did not receive any care outside the home. Of those for whom outside care was sought, 42% were taken to a village doctor. Only 8% were taken to an appropriate provider, i.e. a health facility, a hospital, a doctor, a paramedic, or a community-based health worker. Poorer children than less-poor children were less likely to be taken to an appropriate healthcare provider. The findings indicated that children with severe illness in the least poor households were three times more likely to seek care from a trained provider than children in the poorest households. Any evidence of gender inequities in child healthcare, either in terms of prevalence of illness or care-seeking patterns, was not found. Care-seeking patterns were associated with the perceived severity of illness, the presence of danger signs, and the duration and number of symptoms. The results highlight the challenges that will need to be addressed as IMCI is implemented in health facilities and extended to address key family and community practices, including extremely low rates of use of the formal health sector for the management of sick children. Child health planners and researchers must find ways to address the apparent population preference for untrained and traditional providers which is determined by various factors, including the actual and perceived quality of care, and the differentials in care-seeking practices that discriminate against the poorest households.

The relative contribution of case management and inadequate care‐seeking behaviour to childhood deaths from diarrhoea and acute respiratory infections in Hidalgo, Mexico

Objective To investigate the contribution of poor case management and care-seeking behaviour to childhood deaths from acute respiratory infections (ARI) and diarrhoeal diseases in rural Mexico. Methods Eighty-nine deaths from ARI and diarrhoea in under-fives from Hidalgo over a 7-month period were identified from registered death certificates. We interviewed the carers of 75 of these children, eliciting what happened before death, including signs and symptoms, contact with health services, details on treatments and details of doctors. These death narratives were used to assess the contributions of care seeking and case management to the childhood deaths. We conducted an independent investigation of the clinical competence of doctors mentioned in the death narratives using standard case scenarios and compared this with results obtained from neighbourhood control doctors. Results Late care seeking and/or poor case management contributed to 68% of deaths. The estimated contribution of care seeking alone was 32%, of case management alone 17% and of both care seeking and case management 18% of deaths. Doctors implicated as having contributed to a child's death had significantly lower clinical competence scores than those who were not. Private doctors accounted for 1.4 times more consultations prior to death than public doctors, but were implicated in 1.8 times the number of deaths. Conclusion Efforts to reduce child mortality need to improve both care seeking for childhood illnesses and quality of case management. It is essential that doctors in the private sector be included, as in Mexico and many other countries they provide a large proportion of care, often with adverse outcomes.

Determinants of health care seeking for childhood illnesses in Nairobi slums

The practice of appropriate health seeking has a great potential to reduce the occurrence of severe and life-threatening child illnesses. We assessed the influence of socio-demographic, economic and disease-related factors in health care seeking for child illnesses among slum dwellers of Nairobi, Kenya. A survey round of the Nairobi Urban Demographic Surveillance System (NUDSS) generated information on 2-week child morbidity, illness symptoms, perceived illness severity and use of modern health services. During this round of data collection, interviewers visited a total of 15,174 households, where 3015 children younger than 5 years lived. Of the 999 (33.1%) children who were reported to have been sick, medical care of some sort was sought for 604 (60.5%). Lack of finances (49.6%) and a perception that the illness was not serious (28.1%) were the main reasons given for failure to seek health care outside the home. Health care seeking was most common for sick children in the youngest age group (0-11 months). Caretakers sought medical care more frequently for diarrhoea symptoms than for coughing and even more so when the diarrhoea was associated with fever. Perception of illness severity was strongly associated with health care seeking. Household income was significantly associated with health care seeking up to certain threshold levels, above which its effects stabilized. Improving caretaker skills to recognize danger signs in child illnesses may enhance health-seeking behaviour. Integrated Management of Child Illnesses (IMCI) programmes must be accessible free of charge to the urban poor in order to increase health care seeking and bring about improvements in child survival.