Majority of children in developing countries are dying because of preventable infectious disease. Pneumonia, diarrhea, and malaria remained the major killers of children under the age of five. These three diseases account for more than half of all the deaths in that age group. This is because children are not getting access to appropriate treatment [
Prompt diagnosis and appropriate treatment of common childhood illnesses can prevent death and long term illness. However, evidence from several studies show that nearly one-half of caretakers did not take any action within one to two days of their child falling ill [
In Ethiopia, the medical care seeking behavior for the treatment of common childhood illness in health facilities varies from region to region. It ranges from <5% to 72% [
In Ethiopia, government is the main health service provider especially in rural areas. Ethiopia is improving the quality of primary health care facilities and its distribution by expanding physical health infrastructure and by providing training and deploying health extension workers to provide basic curative and preventive health care services in every rural community. However, there were many challenges faced by the program due to lack of transportation, bad road conditions, shortage of trained health workers, and unreliable medical supplies, to mention some [
Maternal education, socioeconomic status of the household, number of children under five years of age in the household, and area of residence were some of the factors related to the utilization of different types of health facilities [
Although provision of treatment for common childhood illnesses in Ethiopia is among the health agenda priorities, few studies have assessed the factors associated with care seeking behavior of caretakers for treatment of common childhood illnesses. Therefore, we undertook further analysis of the EDHS 2011 data for assessing health care seeking behavior of caretakers for common childhood illness using nationally representative data.
The source of the data for the current study was the Ethiopian Demographic and Health Survey which was conducted in 2011 (EDHS 2011). The survey was a large community based cross-sectional survey.
The samples were selected using a two-stage stratified cluster sampling technique. Initially all nine regions were stratified into urban and rural clusters. From 624 enumeration areas (EAs), 187 urban and 437 rural clusters were considered. A total of 18,720 households were included in the survey, 5,610 from urban and 13,110 from rural areas. All care givers with children aged 0–59 months were included in the current analysis.
The children’s record data and household members’ record data were merged to obtain a working dataset. The dataset provided potential household and individual level predictor variables. The analysis in this study was done in three stages. Firstly, children with at least one common childhood illness (diarrhea, ARI, and/or fever) two weeks preceding the survey were identified and subset of the EDHS data was extracted. Accordingly, dataset with 2,842 records was prepared. Secondly, summary measures were analyzed to investigate caretakers’ health seeking behavior for common childhood illnesses. Then, at the third stage, bivariate analysis was conducted using the Pearson’s chi-square test to test whether there were a difference between the child, household, environmental, and parental characteristics and treatment seeking behavior of the caretakers. Multivariable analysis using a complex sample logistic regression model was employed to determine factors associated with the health seeking behavior of caretakers for their children under the age of five with common childhood illnesses. SVY syntax was used to weight the analysis. The analysis was made using STATA 12. First, strata were generated using region and residence as stratification variables. Secondly, a normalized weight was generated. Data were declared as complex survey data. A
Some of the variables used for the analysis of this paper were recategorized. A wealth index was provided in the dataset. It was constructed by combining information on household assets such as ownership of consumer items, types of dwelling, source of drinking water, and availability of electricity into a single index. It is recategorized as poorer and poor as lower, the middle as a middle, and richer and rich as higher. The age of the children were categorized as 0–11 months, 12–23 months, and 24–59 months. The birth order of the child is categorized as 1 (first), 2-3, 4–6, and ≥7.
Dependent variable was constructed as a dichotomous outcome; caretakers who sought care for their children with fever/ARI/diarrhea from formal health care (government health facilities, private hospitals/clinics, and nongovernmental organization clinics) were coded as one and those who did not seek formal care (including purchasing medicines from pharmacy, shop, and traditional healers) were coded as zero.
The DHS survey had ethical clearance from the National Research Ethics Review Committee. Ethical clearance for this study was obtained from the Institutional Review Board of Hawassa University. Official permission was also obtained from MEASURE/DHS to use the data for this analysis.
Totally 11,645 women in reproductive age group (15–49 years) with their children under the age of five were included in the analysis, of which a total of 2,842 caregivers for children under the age of five years reported that their index child had one or more of the three common childhood illnesses in the two weeks preceding the survey. Majority, 9,668 (83%), of caretakers of the children were living in rural area. Seventy-six percent of the ages of the caretakers of the children were below 35 years of age. Caretakers of 70% of the children had no education and 25% had primary education level.
Of 2,842 caregivers studied, 849 (29.87%; 95% CI: 28, 32%) sought health care for their ill children. Among those who sought care, the most frequent first option for treatment of a child with common childhood illness was primary health care facilities followed by higher hospital. For more details, please see Figure
Among those who sought care, first option place of caretakers for the treatment of childhood illness.
Proportion of children reported suffering from common childhood illness in the two weeks preceding the survey.
As depicted in Table
Proportion of children under the age of five with common childhood illness who sought formal medical care by selected characteristics descriptive statistics with Pearson’s Chi square.
Name of the variables | Sought formal care | Did not seek formal care | Pearson’s Chi square |
---|---|---|---|
Age of the child | |||
0–11 | 187 (27.79) | 486 (72.21) |
Chi2 ( |
12–23 | 231 (32.17) | 487 (67.83) | |
24–59 | 423 (29.83) | 995 (70.17) | |
Sex | |||
Male | 448 (30.46) | 1,023 (69.54) | Chi2 ( |
Female | 401 (29.25) | 970 (70.75) | |
Number of U5 children | |||
≤2 | 726 (30.74) | 1,636 (69.26) | Chi2 ( |
>2 | 123 (25.62) | 357 (74.38) | |
Birth order of the child | |||
First | 210 (41.67) | 294 (58.33) | Chi2 ( |
2-3 | 282 (31) | 627 (69) | |
4–6 | 255 (27.39) | 676 (72.61) | |
≥7 | 102 (20.48) | 396 (79.52) | |
Residence | |||
Urban | 223 (50.23) | 221 (49.77) | Chi2 ( |
Rural | 626 (26.11) | 1,772 (73.89) | |
Distance | |||
Not big problem | 279 (39) | 436 (61) | Chi2 ( |
A big problem | 570 (26.82) | 1,555 (73.18) | |
Transport | |||
Not a problem | 244 (39.61) | 372 (60.39) | Chi2 ( |
Big problem | 605 (27.19) | 1,620 (72.81) | |
Wealth | |||
Lower | 322 (22.41) | 1,115 (77.59) | Chi2 ( |
Middle | 135 (29.16) | 328 (70.84) | |
Higher | 392 (43.5) | 550 (58.39) | |
Money | |||
Not a problem | 285 (35.80) | 511 (64.2) | Chi2 ( |
Big problem | 564 (27.58) | 1,481 (72.42) |
In multivariable analysis, exposure to mass media, birth order of the child, and wealth were the statistically significant factors. Those caretakers who had exposure to mass media, for example, listening to the radio at least once a week, were more likely to seek formal care for their child with common childhood illness (AOR = 1.5; 95% CI: 1, 2.1). The higher the birth order of the child the lower the health care seeking behavior of caretakers for their children with common childhood illness (AOR = 0.5; 95% CI: 0.3, 1). Caregivers at a higher wealth index category are more likely to seek formal care for their child with common childhood illness (AOR = 1.6; 95% CI: 1.1, 2.4). For more details please see Table
Multivariable analysis of factors associated with health seeking behavior of caretakers for their child with common childhood illness in children under the age of five in Ethiopia (from EDHS data 2011).
Sought formal care | Did not seek formal care | COR (95% CI) | AOR (95% CI) | |
---|---|---|---|---|
Age of the child in months | ||||
0, 11 | 187 (27.79) | 486 (72.21) | 1 | 1 |
12, 23 | 231 (32.17) | 487 (67.83) | 1.3 (0.9, 1.8) | 1.3 (0.9, 1.9) |
24, 59 | 423 (29.83) | 995 (70.17) | 1.2 (0.8, 1.6) | 1.1 (0.8, 1.6) |
Sex of the child | ||||
Male | 448 (30.46) | 1,023 (69.54) | 1 | 1 |
Female | 401 (29.25) | 970 (70.75) | 0.9 (0.7, 1.2) | 0.9 (0.7, 1.2) |
Birth order of the child | ||||
First | 210 (41.67) | 294 (58.33) | 1 | 1 |
2, 3 | 282 (31.02) | 627 (68.98) | 0.7 (0.5, 1.1) | 0.8 (0.6, 1.3) |
4, 6 | 255 (27.39) | 676 (72.61) | 0.7 (0.5, 1) |
0.9 (0.6, 1.4) |
≥7 | 102 (20.48) | 396 (79.52) | 0.3 (0.2, 0.5) |
0.5 (0.3, 1) |
Residence | ||||
Urban | 223 (50.23) | 221 (49.77) | 1 | 1 |
Rural | 626 (26.11) | 1772 (73.89) | 0.4 (0.3, 0.7) |
0.8 (0.4, 1.3) |
Maternal education | ||||
No education | 497 (25.49) | 1,453 (74.51) | 1 | 1 |
Primary | 274 (35.96) | 488 (64.04) | 1.5 (1.1, 2) |
1.1 (0.8, 1.5) |
Secondary and higher | 78 (60) | 52 (40) | 4.2 (2.4, 7.3) |
1.6 (0.6, 4) |
Paternal education | ||||
Not educated | 328 (23.53) | 1,066 (76.47) | 1 | 1 |
Primary | 347 (32.16) | 732 (67.84) | 1.3 (0.9, 1.7) | 0.9 (0.7, 1.3) |
Secondary | 89 (48.63) | 94 (51.37) | 2.5 (1.4, 4.4) |
1.3 (0.7, 2.5) |
Higher | 62 (50.41) | 61 (49.59) | 3.3 (1.8, 6) |
1.4 (0.6, 3.1) |
Wealth | ||||
Lower | 322 (22.41) | 1,115 (77.59) | 1 | 1 |
Middle | 135 (29.16) | 328 (70.84) | 1.5 (1.1, 2.2) | 1.5 (1, 2.1) |
Higher | 392 (41.61) | 550 (58.39) | 2.2 (1.6, 3) |
1.6 (1.1, 2.4) |
Maternal age | ||||
15, 24 | 234 (34.21) | 450 (65.79) | 1 | 1 |
25, 29 | 285 (31.67) | 615 (68.33) | 0.8 (0.6, 1.2) | 0.9 (0.6, 1.3) |
30, 34 | 176 (30.34) | 404 (69.66) | 0.8 (0.6, 1.2) | 1.1 (0.6, 1.7) |
35, 49 | 154 (22.71) | 524 (77.29) | 0.5 (04, 0.7) |
0.8 (0.5, 1.3) |
Transport | ||||
Not a problem | 244 (39.61) | 372 (60.39) | 1 | 1 |
Big problem | 605 (27.19) | 1,620 (72.81) | 0.7 (0.5, 0.9) |
1 (0.7, 1.4) |
Watching TV | ||||
Not at all | 544 (26.81) | 1,485 (73.19) | 1 | 1 |
Less than once a week | 166 (30.97) | 370 (69) | 1.5 (1.1, 2.2) |
1.2 (0.9, 1.8) |
At least once a week | 137 (49.82) | 138 (50.18) | 2.1 (1.3, 3.2) |
1 (0.6, 1.7) |
Listening to the radio | ||||
Not at all | 431 (27) | 1,166 (73) | 1 | 1 |
Less than once a week | 234 (30) | 547 (70) | 1.1 (0.8, 1.5) | 0.9 (0.7, 1.2) |
At least once a week | 183 (39.52) | 280 (60.48) | 1.9 (1.3, 2.7) |
1.5 (1, 2.1) |
Reading news | ||||
Not at all | 740 (28.2) | 1,884 (71.8) | 1 | 1 |
Less than once a week | 84 (49.41) | 86 (50.59) | 2.7 (1.8, 4.3) |
1.5 (0.9, 2.7) |
At least once a week | 24 (52.17) | 22 (47.83) | 1.8 (0.8, 4.2) | 0.4 (0.1, 1.3) |
Overall, less than one-third of caretakers of children under the age of five years with common childhood illness seek formal health care. Health care seeking from formal health care system was better for those caretakers who were exposed to mass media and with higher wealth status. Children born from large family size are also less likely to get immediate care from formal health facilities.
Appropriate health seeking behavior of caretakers is very low in this study compared to similar studies done in Nepal, Myanmar, Cambodia, Yemen, Tanzania, and Kenya [
The study revealed that caretakers who had two and more under-five children are less likely to seek formal health care compared to those who had one. Formal health care seeking among caretakers are also associated with family size. The larger the size of the family, the lower the caretakers to seek formal health care. This shows that children born to large family size are less likely to get formal health care. This finding is in line with studies done in Tanzania [
The result also revealed that those caretakers from higher wealth seek more formal health care compared to the lower wealth. This is also similar to the studies done in Nepal, Cambodia, and Ghana [
Primary health care facilities were among the most common care provider. This result is also in line with different studies done in Cambodia, Ghana, and Tanzania [
This study revealed that those caretakers who had exposure to mass media (listening to radio at least once a week) seek more formal care than those who do not. The finding is also similar to the study done in Cambodia [
The limitations of this study include the data set lacks variable such as at what time caretakers sought medical advice. It is important to check how fast a caretaker acting for the illness. However, the rest of the variables are robust and representative of the country; as a result the findings of this study are generalizable.
In conclusion, health care seeking behavior of caretakers in Ethiopia is low; less than one-third of caretakers sough formal heath care. Among those who sought formal health care, primary health care facilities were the most common care providers. Exposure to mass media appears to have played a role in motivating health care seeking behavior and family planning is also important to maximize health seeking behavior of the caretakers.
The authors declare that they have no conflict of interests.
The authors gratefully acknowledge Measure DHS for providing them with the permission to use the dataset for this study. The school of Public and Environmental Health, Medicine and Health Science College of Hawassa University; and Addis Continental Institute of Public Health are acknowledged for their support during this study.