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Marsh A, Hirve S, Lele P, Chavan U, Bhattacharjee T, Nair H, Juvekar S, Campbell H. Determinants and patterns of care-seeking for childhood illness in rural Pune District, India. J Glob Health 2020; 10:010601. [PMID: 32082546 PMCID: PMC7020658 DOI: 10.7189/jogh.10.010601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND An estimated 1.2 million children under five years of age die each year in India, with pneumonia and diarrhea among the leading causes. Increasing care-seeking is important to reduce mortality and morbidity from these causes. This paper explores the determinants and patterns of care-seeking for childhood illness in rural Pune district, India. METHODS Mothers having at least one child <5 years from the study area of the Vadu Health and Demographic Surveillance System were enrolled in a prospective cohort study. Household sociodemographic information was collected through a baseline questionnaire administered at enrollment. Participants were visited up to six times between July 2015 and February 2016 to collect information on recent childhood acute illness and associated care-seeking behavior. Multivariate logistic regression explored the associations between care-seeking and child, participant, and household characteristics. RESULTS We enrolled 743 mothers with 1066 eligible children, completing 2585 follow-up interviews (90% completion). Overall acute illness prevalence in children was 26% with care sought from a health facility during 71% of episodes. Multivariable logistic regression showed care-seeking was associated with the number of reported symptoms (Odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.5-3.9) and household insurance coverage (OR = 2.2, 95% CI = 1.1-4.3). We observed an interaction between the associations of illness severity and maternal employment on care-seeking. Somewhat-to-very severe illness was associated with increased care-seeking among both employed (OR = 5.0, 95% CI = 2.2-11.1) and currently unemployed mothers (OR = 7.0, 95% CI = 3.9-12.6). Maternal employment was associated with reduced care-seeking for non-severe illness (OR = 0.3, 95% CI = 0.1-0.7), but not associated with care-seeking for somewhat-to-very severe illness. Child sex was not associated with care-seeking. CONCLUSIONS This study demonstrates the importance of illness characteristics in determining facility-based care-seeking while also suggesting that maternal employment resulted in decreased care-seeking among non-severe illness episodes. The nature of the association between maternal employment and care-seeking is unclear and should be explored through additional studies. Similarly, the absence of male bias in care-seeking should be examined to assess for potential bias at other stages in the management of childhood illness.
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Affiliation(s)
- Andrew Marsh
- Institute for International Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- KEM Hospital Research Centre, Rasta Peth, Pune, India
| | | | - Pallavi Lele
- KEM Hospital Research Centre, Rasta Peth, Pune, India
| | | | - Tathagata Bhattacharjee
- KEM Hospital Research Centre, Rasta Peth, Pune, India
- INDEPTH Network, East Legon, Accra, Ghana
| | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, UK
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Rasta Peth, Pune, India
- INDEPTH Network, East Legon, Accra, Ghana
- Joint last author with equal contributions
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, UK
- Joint last author with equal contributions
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Workman CL. Perceptions of drinking water cleanliness and health-seeking behaviours: A qualitative assessment of household water safety in Lesotho, Africa. Glob Public Health 2019; 14:1347-1359. [PMID: 30657028 DOI: 10.1080/17441692.2019.1566483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite the increased availability of improved water sources globally, enteric illnesses remain a source of significant morbidity and mortality. While the MDGs goal for safe water, i.e. improved sources, was met, substantial numbers of people still rely on unimproved sources for at least some of their water needs and contamination can occur between the source and consumption. Reviews and meta-analyses point to the need for better understanding of the cultural context for (HWT) technologies. Qualitative interviews (n = 56) conducted in the Maseru District of Lesotho (2011) addressed how people decided if their water was safe, their understanding of the linkage between water and enteric illness, and health-seeking behaviour. Respondents overwhelmingly relied on visual inspections to determine if their water was clean and not all participants linked consuming unsafe water with diarrheal disease. More than half of all respondents did not boil their water, despite believing that their primary source was not clean. People often have the knowledge necessary to ensure safe water but do not for myriad reasons, including financial constraints or habit. Data such as these are critical as the literature reveals often conflicting findings about the effectiveness of HWT and water safety takes on increasing importance in syndemic settings.
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Affiliation(s)
- Cassandra L Workman
- a Department of Sociology and Anthropology , Global WaSH Cluster, North Carolina State University , Raleigh , NC , USA
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Eckhardt M, Santillán D, Faresjö T, Forsberg BC, Falk M. Universal Health Coverage in Rural Ecuador: A Cross-sectional Study of Perceived Emergencies. West J Emerg Med 2018; 19:889-900. [PMID: 30202504 PMCID: PMC6123085 DOI: 10.5811/westjem.2018.6.38410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/15/2018] [Accepted: 06/29/2018] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION In many low- and middle-income countries emergency care is provided anywhere in the health system; however, no studies to date have looked at which providers are chosen by patients with perceived emergencies. Ecuador has universal health coverage that includes emergency care. However, earlier research indicates that patients with emergencies tend to seek private care. Our primary research questions were these: What is the scope of perceived emergencies?; What is their nature?; and What is the related healthcare-seeking behavior? Secondary objectives were to study determinants of healthcare-seeking behavior, compare health expenditure with expenditure from the past ordinary illness, and measure the prevalence of catastrophic health expenditure related to perceived emergencies. METHODS We conducted a cross-sectional survey of 210 households in a rural region of northwestern Ecuador. The households were sampled with two-stage cluster sampling and represent an estimated 20% of the households in the region. We used two structured, pretested questionnaires. The first questionnaire collected demographic and economic household data, expenditure data on the past ordinary illness, and presented our definition of perceived emergency. The second recorded the number of emergency events, symptoms, further case description, healthcare-seeking behavior, and health expenditure, which was defined as being catastrophic when it exceeded 40% of a household's ability to pay. RESULTS The response rate was 85% with a total of 74 reported emergency events during the past year (90/1,000 inhabitants). We further analyzed the most recent event in each household (n=54). Private, for-profit providers, including traditional healers, were chosen by 57.4% (95% confidence interval [CI] [44-71%]). Public providers treated one third of the cases. The mean health expenditure per event was $305.30 United States dollars (USD), compared to $135.80 USD for the past ordinary illnesses. Catastrophic health expenditure was found in 24.4% of households. CONCLUSION Our findings suggest that the provision of free health services may not be sufficient to reach universal health coverage for patients with perceived emergencies. Changes in the organization of public emergency departments and improved financial protection for emergency patients may improve the situation.
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Affiliation(s)
- Martin Eckhardt
- Linköping University, Department of Medical and Health Sciences, Division of Community Medicine, Linköping, Sweden
| | - Dimitri Santillán
- Universidad Central del Ecuador, Facultad de Ciencias Médicas, Quito, Ecuador
| | - Tomas Faresjö
- Linköping University, Department of Medical and Health Sciences, Division of Community Medicine, Linköping, Sweden
| | - Birger C. Forsberg
- Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden
| | - Magnus Falk
- Linköping University, Department of Medical and Health Sciences, Division of Community Medicine, Linköping, Sweden
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Zaman SB, Gupta RD, Al Kibria GM, Hossain N, Bulbul MMI, Hoque DME. Husband's involvement with mother's awareness and knowledge of newborn danger signs in facility-based childbirth settings: a cross-sectional study from rural Bangladesh. BMC Res Notes 2018; 11:286. [PMID: 29743103 PMCID: PMC5944176 DOI: 10.1186/s13104-018-3386-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/30/2018] [Indexed: 12/19/2022] Open
Abstract
Objective The aim of this study was to examine the association between husband involvement and maternal awareness and knowledge of newborn danger signs. This cross-sectional study was conducted in three rural hospitals of Bangladesh among the recently delivered women (RDW). Results RDW were interviewed to determine their knowledge and understanding of seven key neonatal danger signs. About 51.4% of the respondents were able to identify at least one danger sign. ‘Fever’ was the most correctly identified (43.7%), and hypothermia was the least (26.1%) identified danger sign. The factors associated with RDW possessing knowledge of at least one neonatal danger sign were: secondary education (COR: 1.3, 95% CI 1.1–1.6), increased ANC visits (COR: 1.2, 95% CI 1.1–1.3), previous history of facility delivery (COR: 1.3, 95% CI 1.1–1.4), and husband involvement in the mother’s facility delivery (COR: 1.3, 95% CI 1.1–1.5). RDW were more likely to recall at least one newborn danger sign (AOR: 1.2, 95% CI 1.1–1.4) when the husband was actively involved in his wife’s antenatal, delivery and postnatal care. In conclusion, this study found that husband involvement was significantly associated with the maternal knowledge related to identification of neonatal danger signs. Electronic supplementary material The online version of this article (10.1186/s13104-018-3386-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Rajat Das Gupta
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Gulam Muhammed Al Kibria
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Naznin Hossain
- Department of Pharmacology, Dhaka Medical College, Dhaka, Bangladesh
| | - Md Mofijul Islam Bulbul
- Public Health and World Health Wing, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Dewan Md Emdadul Hoque
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Community unit performance: factors associated with childhood diarrhea and appropriate treatment in Nyanza Province, Kenya. BMC Public Health 2017; 17:202. [PMID: 28209194 PMCID: PMC5314605 DOI: 10.1186/s12889-017-4107-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 02/03/2017] [Indexed: 01/09/2023] Open
Abstract
Background The government of Kenya launched its community health strategy in 2006 to improve certain aspects of its community health program. Under the strategy, community units (CUs) were established as level one of the Kenyan health system. A core member at this level is the community health worker (CHW). The objective of this study was to assess the relationship among the performance of the CUs, the prevalence of childhood diarrhea and appropriate treatment for it by controlling individual and community-level factors. Methods The main dataset used in this study was the 2011 Nyanza Province county-based Multiple Indicator Cluster Survey (MICS). In addition, based on the list of community units in Nyanza Province, Kenya, we identified the area’s CUs and their performance. MICS data and data on CUs were merged using sub-location names. There were 17 individual and two community-level independent variables in this study. Bivariate analysis and a multilevel logistic regression were performed. Results Factors significantly associated with a lower prevalence of diarrhea among children under five were the child’s increasing age, middle-aged household heads, children who received more attention, water treatment and rural versus urban area residence, while male children and highly performing CUs were significantly associated with a higher prevalence of diarrhea. In addition, middle wealth index, severity of diarrhea and middle- and high-CU performance were significantly associated with appropriate treatment for childhood diarrhea. Conclusions Although this study found that children living in areas of high CU performance were more likely to have diarrhea, these areas would have been identified as being more at risk for diarrhea prevalence and other health concerns, prioritized for the establishment of a CU and allocated more resources to improve the performance of CUs. A higher CU performance was significantly associated with the appropriate treatment. It was suggested that CHWs could have a positive effect on the community, as demonstrated and promoted by appropriate health-seeking behavior and treatment for childhood diarrhea.
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Shah R, Mullany LC, Darmstadt GL, Talukder RR, Rahman SM, Mannan I, El Arifeen S, Baqui AH. Determinants and pattern of care seeking for preterm newborns in a rural Bangladeshi cohort. BMC Health Serv Res 2014; 14:417. [PMID: 25242278 PMCID: PMC4261985 DOI: 10.1186/1472-6963-14-417] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the increased burden of preterm birth and its complications, the dearth of care seeking data for preterm newborns remains a significant knowledge gap. Among preterm babies in rural Bangladesh, we examined: 1) determinants and patterns of care seeking, and 2) risk analysis for care-seeking from qualified and unqualified providers. METHOD Trained community health workers collected data prospectively from 27,460 mother-liveborn baby pairs, including 6,090 preterm babies, between June 2007 and September 2009. Statistical analyses included binomial and multinomial logistic regressions. RESULTS Only one-fifth (19.7%) of preterm newborns were taken to seek either preventive or curative health care. Among care-seeker preterm newborns, preferred providers included homeopathic practitioners (50.0%), and less than a third (30.9%) sought care from qualified providers. Care-seeking from either unqualified or qualified providers was significantly lower for female preterm babies, compared to male babies [Relative Risk Ratio (RRR) for unqualified care: 0.68; 95% Confidence Interval (CI): 0.58, 0.80; RRR for qualified care: 0.52; 95% CI: 0.41, 0.66]. Among preterm babies, care-seeking was significantly higher among caregivers who recognized symptoms of illness [RR: 2.14; 95% CI: 1.93, 2.38] or signs of local infection (RR: 2.53; 95% CI: 2.23, 2.87), had a history of child death [RR: 1.21; 95% CI: 1.07, 1.37], any antenatal care (ANC) visit [RR: 1.41; 95% CI: 1.25, 1.59]. Birth preparedness (RRR: 1.24; 95% CI: 1.09, 1.68) and any ANC visit (RRR: 1.73; 95% CI: 1.50, 2.49) were also associated with increased likelihood of care seeking for preterm babies from qualified providers. CONCLUSION To improve care seeking practices for preterm babies and referral of sick newborns to qualified providers/facilities, we recommend: 1) involving community-preferred health care providers in community-based health education and awareness raising programs; 2) integrating postnatal care seeking messages into antenatal counselling; and 3) further research on care seeking practices for preterm babies.
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Affiliation(s)
- Rashed Shah
- />Department of International Health, International Center for Maternal and Newborn Health (ICMNH), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
- />Department of Health and Nutrition, Save the Children-USA, Washington, DC USA
| | - Luke C Mullany
- />Department of International Health, International Center for Maternal and Newborn Health (ICMNH), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
| | - Gary L Darmstadt
- />Global Development Division, Bill and Melinda Gates Foundation, Seattle, WA USA
| | - Radwanur Rahman Talukder
- />International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Syed Moshfiqur Rahman
- />International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Ishtiaq Mannan
- />Ma-Moni Project, MCHIP/Save the Children, Bangladesh Country office, Dhaka, Bangladesh
| | - Shams El Arifeen
- />International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Abdullah H Baqui
- />Department of International Health, International Center for Maternal and Newborn Health (ICMNH), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
- />International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - on behalf of the ProjAHNMo Study Group in Bangladesh
- />Department of International Health, International Center for Maternal and Newborn Health (ICMNH), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
- />Department of Health and Nutrition, Save the Children-USA, Washington, DC USA
- />Global Development Division, Bill and Melinda Gates Foundation, Seattle, WA USA
- />International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
- />Ma-Moni Project, MCHIP/Save the Children, Bangladesh Country office, Dhaka, Bangladesh
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Mizumoto K, Takahashi T, Kinoshita Y, Higuchi M, Bachroen C, Da Silva V. A qualitative study of risk factors related to child malnutrition in Aileu District, Timor-Leste. Asia Pac J Public Health 2013; 27:NP1398-408. [PMID: 23674826 DOI: 10.1177/1010539513486175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Improvement in child nutritional status is one of the major health priorities in Timor-Leste. A qualitative study was conducted in Aileu District, adjacent to the capital of Timor-Leste, Dili, in September 2010 to determine the possible risk factors associated with the high prevalence of child malnutrition. In-depth interviews were conducted to 32 guardians of children aged younger than 5 years. It was observed that early termination of exclusive breast-feeding and a short lactation period along with an unsanitary living environment were associated with the nutritional status of children in the study area. Although previous surveys have reported poor food security conditions in the country, no statements from the subjects supported this contention. The identified possible risk factors for child malnutrition were closely linked to each other and were mostly modifiable.
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Affiliation(s)
- Kaori Mizumoto
- Faculty of Human Environmental Sciences, Fukuoka Women's University, Fukuoka, Japan
| | - Toru Takahashi
- Faculty of Human Environmental Sciences, Fukuoka Women's University, Fukuoka, Japan
| | - Yuri Kinoshita
- Department of Food Science, Shizuoka Eiwa Gakuin University Junior College, Shizuoka, Japan
| | | | - Cholis Bachroen
- Department of Health Research and Development, Ministry of Health, Dili, Timor-Leste
| | - Valente Da Silva
- Department of Health Research and Development, Ministry of Health, Dili, Timor-Leste
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Mayxay M, Hansana V, Sengphilom B, Oulay L, Thammavongsa V, Somphet V, Taykeophithoune C, Nathavong S, Phanthady J, Chareunvong K, Chanthavilay P, Sychareun V. Respiratory illness healthcare-seeking behavior assessment in the Lao People's Democratic Republic (Laos). BMC Public Health 2013; 13:444. [PMID: 23642240 PMCID: PMC3689642 DOI: 10.1186/1471-2458-13-444] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 04/30/2013] [Indexed: 11/21/2022] Open
Abstract
Background Respiratory illness (RI) remains a public health problem in Laos, but little is known about the overall burden and people’s healthcare-seeking behavior for RI. Understanding the burden of RI and community patterns of healthcare-seeking behavior would provide better guidance for Lao public health program and policy planners to improve RI public health practice, surveillance systems, and prevention strategies. Methods A quantitative and qualitative survey was conducted in 14 randomly selected villages of two purposively selected peri-urban and two rural provinces in Laos. A pre-designed and pre-tested questionnaire was used to collect information on RI in household members (defined as new fever with cough and/or sore-throat in the absence of other diagnoses during the preceding 30 days) from all heads of household in each village. Sixteen focus group discussions were conducted to obtain more information to support the quantitative survey. Results Among 1,751 households (9,114 people) studied, 3.5% (317/9,114) had experienced RI (fever, cough, and/or sore-throat) in the 30 days before the survey [6.2% in rural and 2.4% in peri-urban areas (p<0.001)]. The percentage of RI among persons aged ≥15 years was 2.7%, 3.7% for those aged 5 – 14 years, and 8.2% for children < 5 years (p<0.001). Of all sick persons, 71% sought treatment [94% in peri-urban and 48% in rural areas (p<0.001)] and 31.5% of them self-medicated [55.5% in peri-urban and 29% in rural areas (p<0.001)]. Sick people in peri-urban areas preferred to chose private clinics and pharmacies as their first treatment option while in rural areas they frequently consulted with village health volunteers and visited health centres as their first choice. The qualitative study suggests that distance, costs of care, and service availability are the most important determinants of seeking healthcare. Conclusions The RI burden and healthcare-seeking behavior are different between rural and peri-urban areas of Laos and this is probably due to the differences in environmental and hygienic conditions, health service availability and socio-economic status between the two areas. Therefore strategies for healthcare service improvement may also need to differ between the two areas.
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Affiliation(s)
- Mayfong Mayxay
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR.
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Blum LS, Oria PA, Olson CK, Breiman RF, Ram PK. Examining the use of oral rehydration salts and other oral rehydration therapy for childhood diarrhea in Kenya. Am J Trop Med Hyg 2012; 85:1126-33. [PMID: 22144457 DOI: 10.4269/ajtmh.2011.11-0171] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Reductions in the use of oral rehydration therapy (ORT) in sub-Saharan Africa highlight the need to examine caregiver perceptions of ORT during diarrheal episodes. Qualitative research involving group discussions with childcare providers and in-depth interviews with 45 caregivers of children < 5 years of age who had experienced diarrhea was conducted in one rural and urban site in Kenya during July-December 2007. Diarrhea was considered a dangerous condition that can kill young children. Caregivers preferred to treat diarrhea with Western drugs believed to be more effective in stopping diarrhea than ORT. Inconsistent recommendations from health workers regarding use of oral rehydration solution (ORS) caused confusion about when ORS is appropriate and whether it requires a medical prescription. In the rural community, causal explanations about diarrhea, beliefs in herbal remedies, cost, and distance to health facilities presented additional barriers to ORS use. Health communication is needed to clarify the function of ORT in preventing dehydration.
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Kassegne S, Kays MB, Nzohabonayo J. Evaluation of a social marketing intervention promoting oral rehydration salts in Burundi. BMC Public Health 2011; 11:155. [PMID: 21385460 PMCID: PMC3062608 DOI: 10.1186/1471-2458-11-155] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 03/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diarrhea is the second leading cause of death for children under five in Burundi; however, use of oral rehydration salts (ORS), the recommended first-line treatment, remains low. In 2004, PSI/Burundi launched a social marketing intervention to promote ORASEL among caregivers of children under five; the product was relaunched in 2006 with a new flavor. This study evaluates the intervention after the ORASEL relaunch, which included mass media and interpersonal communication activities. The study looks at trends in ORASEL use in Burundi and in behavioral determinants that may be related to its use. METHODS In 2006 and 2007, PSI conducted household surveys among Burundian females of reproductive age (15-49). Both surveys used a two-stage sampling process to select 30 households in each of 115 rural and urban collines throughout the nation. Survey respondents were asked about diarrhea treatment-related behavior; key behavioral determinants; and exposure to the ORASEL intervention. Data were analyzed to identify trends over time, characteristics of ORASEL users, and associations between exposure to the intervention and changes in ORASEL use and related behavioral determinants. RESULTS ORASEL use among caregivers at their children's last diarrheal episode increased significantly from 20% in 2006 to 30% in 2007, and there were also desirable changes in several behavioral determinants associated with ORASEL use. Evaluation analysis showed that a higher level of exposure to the social marketing campaign was associated with greater use of ORASEL and with significant improvements in perceived availability, knowledge of the signs of diarrhea and dehydration, social support, and self-efficacy. CONCLUSIONS ORS use can be improved through social marketing and educational campaigns that make the public aware of the availability of the product, encourage dialogue about its use, and increase skills and confidence relating to correct product preparation and administration. Further interventions in Burundi and elsewhere should promote ORS through a variety of mass media and interpersonal communication channels, and should be rigorously evaluated in the context of the total market for diarrhea treatment products.
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Affiliation(s)
- Sethson Kassegne
- Population Services International/Benin, B.P. 08-0876 Tri Postal Cotonou, Benin
| | - Megan B Kays
- Population Services International, 1120 Nineteenth Street NW, Suite 600, Washington, D.C. 20036, USA
| | - Jerome Nzohabonayo
- Population Services International/Burundi, B.P. 1474 Bujumbura, Republique du Burundi
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Choi Y, El Arifeen S, Mannan I, Rahman SM, Bari S, Darmstadt GL, Black RE, Baqui AH. Can mothers recognize neonatal illness correctly? Comparison of maternal report and assessment by community health workers in rural Bangladesh. Trop Med Int Health 2010; 15:743-53. [PMID: 20406425 DOI: 10.1111/j.1365-3156.2010.02532.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To validate maternal recognition of neonatal illnesses at home compared to assessment by community health workers (CHWs) during routine household surveillance for neonatal illness in rural Bangladesh. METHODS Surveillance in the intervention arm of two cluster-randomized, controlled trials of newborn interventions conducted in Sylhet and Mirzapur districts of Bangladesh. CHWs promoted birth and newborn care preparedness during two prenatal visits, including recognition of neonatal illnesses. CHWs assessed 8472 neonates on post-natal days 0, 3, and 6 between 2004 and 2005 in Sylhet, and 7587 neonates on post-natal days 0, 2, 5, and 8 between 2004 and 2006 in Mirzapur. In both sites, CHW identified neonates with very severe disease (VSD), using clinical algorithms that included ascertainment of illness history reported by mother and observation of clinical signs of illness. We calculated sensitivity, specificity, positive predictive value and negative predictive value of maternal report of any illness sign compared to CHWs' assessments and classification of VSD. Analysis was restricted to mothers whose neonates were assessed by CHWs at home during the routine visit schedule. RESULTS Maternal report of any signs had sensitivity of 24% and 20% and positive predictive value of 45% and 54% in Sylhet and Mirzapur, respectively. CONCLUSIONS Maternal recognition of neonatal illnesses at home was poor in two rural areas in Bangladesh. Interventions need to be designed to improve maternal recognition, and routine post-natal assessment by CHWs at home may be an essential component of community-based newborn care to improve care-seeking for newborn illness.
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Affiliation(s)
- Y Choi
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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Friend-du Preez N, Cameron N, Griffiths P. Stuips, spuits and prophet ropes: The treatment of abantu childhood illnesses in urban South Africa. Soc Sci Med 2009; 68:343-51. [DOI: 10.1016/j.socscimed.2008.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Indexed: 10/21/2022]
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Sreeramareddy CT, Shankar RP, Sreekumaran BV, Subba SH, Joshi HS, Ramachandran U. Care seeking behaviour for childhood illness--a questionnaire survey in western Nepal. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2006; 6:7. [PMID: 16719911 PMCID: PMC1543657 DOI: 10.1186/1472-698x-6-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Accepted: 05/23/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND The World Health Organization estimates that seeking prompt and appropriate care could reduce child deaths due to acute respiratory infections by 20%. The purpose of our study was to assess care seeking behaviour of the mothers during childhood illness and to determine the predictors of mother's care seeking behaviour. METHODS A cross-sectional survey was conducted in the immunization clinics of Pokhara city, Kaski district, western Nepal. A trained health worker interviewed the mothers of children suffering from illness during the preceding 15 days. RESULTS A total of 292 mothers were interviewed. Pharmacies (46.2%) were the most common facilities where care was sought followed by allopathic medical practitioners (26.4%). No care was sought for 8 (2.7%) children and 26 (8.9%) children received traditional/home remedies. 'Appropriate', 'prompt' and 'appropriate and prompt' care was sought by 77 (26.4%), 166 (56.8%) and 33 (11.3%) mothers respectively. The mothers were aware of fever (51%), child becoming sicker (45.2%) and drinking poorly (42.5%) as the danger signs of childhood illness. By multiple logistic regression analysis total family income, number of symptoms, mothers' education and perceived severity of illness were the predictors of care seeking behaviour. CONCLUSION The results of the present study show that the mothers were more likely to seek care when they perceived the illness as 'serious'. Poor maternal knowledge of danger signs of childhood illness warrants the need for a complementary introduction of community-based Integrated Management of Childhood Illness programmes to improve family's care seeking behaviour and their ability to recognize danger signs of childhood illness. Socioeconomic development of the urban poor may overcome their financial constraints to seek 'appropriate' and 'prompt' care during the childhood illness.
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Affiliation(s)
| | - Ravi P Shankar
- Department of Pharmacology, Manipal College of Medical Sciences, P.O. Box: 155,"Deep Heights", Pokhara, Nepal
| | - Binu V Sreekumaran
- Department of Community Medicine, Manipal College of Medical Sciences, P.O. Box: 155,"Deep Heights", Pokhara, Nepal
| | - Sonu H Subba
- Department of Community Medicine, Manipal College of Medical Sciences, P.O. Box: 155,"Deep Heights", Pokhara, Nepal
| | - Hari S Joshi
- Department of Community Medicine, Manipal College of Medical Sciences, P.O. Box: 155,"Deep Heights", Pokhara, Nepal
| | - Uma Ramachandran
- Department of Pediatrics, Manipal College of Medical Sciences, P.O. Box: 155,"Deep Heights", Pokhara, Nepal
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Abstract
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.
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Affiliation(s)
- Negussie Taffa
- African Population and Health Research Center, Nairobi, Kenya.
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Abstract
This paper uses the 1995 Guatemalan Survey of Family Health (EGSF) to analyze the relationship between child illness and health seeking behavior. The EGSF contains detailed calendar data on the nature and timing of illness and treatment behavior for children age five and below; extensive information about the characteristics of mothers, families and communities; and data on the accessibility of traditional and biomedical providers within and near the community. The analysis is based on 870 children who began a diarrheal or respiratory illness during a 2-week period prior to interview. Estimates are derived from a multinomial logit model of the probability of seeing a specific type of provider on a given day of illness, as a function of characteristics of the illness, child, mother, and community. The results indicate that modern medical care plays a major role in the treatment of infectious illness among children in rural Guatemala. The symptoms associated with the illness, their perceived severity, and mother's beliefs about their causes are important determinants of whether a child is brought to a provider and the type of provider visited. Poverty is a serious constraint on a family's choices about how to treat children's illnesses, whereas education and ethnicity have little effect on treatment behavior when income is held constant. In addition, the availability of modern health facilities within the community-both government-sponsored facilities and private doctors-has a substantial impact on the type of providers sought to treat children's illnesses.
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Affiliation(s)
- Noreen Goldman
- Office of Population Research, Princeton University, Wallace Hall, Princeton, NJ 08540, USA.
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16
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Abstract
Relying on data from the 1995 Guatemalan Survey of Family Health (EGSF), we analyse the relationship between child illness and health-seeking behaviour. Information on illness was collected for 3193 children. This analysis is based on 870 of these who became ill with diarrhoeal or respiratory disease during a 13-day period prior to interview. Estimates are derived from logistic models of the probability of seeing any or a specific type of health care provider as a function of characteristics of the illness on a given day and the child. The results indicate that modern medical care plays a major role in the treatment of infectious illness among children in rural Guatemala, with visits to pharmacists, doctors and the staff at government health facilities occurring much more frequently than visits to curers and other traditional practitioners. In general, families are much more likely to seek out a health care provider when a child experiences fever and gastrointestinal symptoms than when suffering from respiratory and other symptoms, and when a mother perceives the illness to be serious. The results also indicate that infants, low parity children, and children assessed as having generally been in good health are more likely to visit health care providers than other children. However, the particular associations often vary by type of health care provider.
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Affiliation(s)
- N Goldman
- Office of Population Research, Princeton University, Princeton, USA.
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17
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Abstract
This paper uses a new calendar design implemented in the Guatemalan Survey of Family Health to analyze diarrheal and respiratory illness among children. The calendar provides a much richer description of child illness and treatment behavior than do conventional data typically collected in health interview surveys. The resulting estimates reveal that Guatemalan children experience high rates of diarrheal and respiratory illness and that these illnesses often involve multiple symptoms that only partially overlap one another. In addition, estimates from the calendar demonstrate that the measurement of illness frequency is fairly complex and that classification of illness into distinct categories may not always be feasible or meaningful. Results regarding treatment behavior indicate that the vast majority of illnesses are treated and that mothers almost always receive advice regarding their children's illnesses from relatives. On the other hand, health providers are sought for advice and treatment in only about one-third of illnesses. When families do seek providers, they are more likely to rely on biomedical ones - especially pharmacists, doctors and personnel at health posts and centers - than traditional practitioners. By far, the most common form of treatment - recommended by both relatives and providers - consists of readily available Western medicines. In contrast, the use of traditional remedies appears to be relatively low.
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Affiliation(s)
- P Heuveline
- Population Research Center, NORC and The University of Chicago, IL 60637, USA
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