Care seeking behaviour for childhood illness- a questionnaire survey in western Nepal

Chandrashekhar T Sreeramareddy1, P Ravi Shankar2, Binu V Sreekumaran1, Sonu Hangma Subba1, Hari Shankar Joshi1, U Ramachandran3
1Department of Community Medicine, Manipal College of Medical Sciences, Pokhara, Nepal
2Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Nepal
3Department of Pediatrics, Manipal College of Medical Sciences, Pokhara, Nepal

Tóm tắt

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.

Từ khóa


Tài liệu tham khảo

UNICEF: The State of the World's Children. 1995, Oxford University Press, Oxford

Ministry of Health, His Majesty Government: Annual Health Report-2001. 2001, His Majesty Government, Nepal

Sutrisna B, Reingold A, Kresno S, Harrison G, Utomo B: Care-seeking for fatal illnesses in young children in Indramayu, west Java, Indonesia. Lancet. 1993, 342 (8874): 787-9. 10.1016/0140-6736(93)91545-W.

D'Souza RM: Role of health-seeking behaviour in child mortality in the slums of Karachi, Pakistan. J Biosoc Sci. 2003, 35 (1): 131-44. 10.1017/S0021932003001317.

Reyes H, Perez-Cuevas R, Salmeron J, Tome P, Guiscafre H, Gutierrez G: Infant mortality due to acute respiratory infections: the influence of primary care processes. Health Policy Plan. 1997, 12 (3): 214-23. 10.1093/heapol/12.3.214.

Amarasiri de Silva MW, Wijekoon A, Hornik R, Martines J: Care seeking in Sri Lanka: one possible explanation for low childhood mortality. Soc Sci Med. 2001, 53 (10): 1363-72. 10.1016/S0277-9536(00)00425-1.

Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Bellagio : Child Survival Study Group. How many child deaths can we prevent this year?. Lancet. 2003, 362: 65-71. 10.1016/S0140-6736(03)13811-1.

World Health Organization: Technical bases for the WHO recommendations on the management of pneumonia in children at first level health facilities. 1991, Geneva: WHO, (WHO/ARI/91.20.)

World Health Organization: Counsel the mother: management of childhood illnesses. 1997, Geneva: WHO

D'Souza RM: Care seeking behavior. Clin Infect Dis. 1999, 28: 234-

Tarimo DS, Lwihula GK, Minjas JN, Bygbjerg IC: Mothers' perceptions and knowledge on childhood malaria in the holoendemic Kibaha district, Tanzania: implications for malaria control and the IMCI strategy. Trop Med Int Health. 2000, 5 (3): 179-84. 10.1046/j.1365-3156.2000.00537.x.

Thind A, Andersen R: Respiratory illness in the Dominican Republic: what are the predictors for health services utilization of young children?. Soc Sci Med. 2003, 56 (6): 1173-82. 10.1016/S0277-9536(02)00116-8.

Thind A, Cruz AM: Determinants of children's health service utilization in the Philippines. Journal of Tropical Pediatrics. 2003, 49: 260-273. 10.1093/tropej/49.5.260.

Yoder PS, Hornik RC: Symptoms and perceived severity of illness as predictive of treatment for diarrhea in six Asian and African sites. Soc Sci Med. 1996, 43 (4): 429-39. 10.1016/0277-9536(95)00408-4.

Goldman N, Heuveline P: Health-seeking behaviour for child illness in Guatemala. Trop Med Int Health. 2000, 5 (2): 145-55. 10.1046/j.1365-3156.2000.00527.x.

Hill Z, Kendall C, Arthur P, Kirkwood B, Adjei E: Recognizing childhood illnesses and their traditional explanations: exploring options for care-seeking interventions in the context of the IMCI strategy in rural Ghana. Trop Med Int Health. 2003, 8 (7): 668-76. 10.1046/j.1365-3156.2003.01058.x.

Andersen R, Rice TH, Kominski GF: Changing the US Health Care System: Key Issues in Health Services, Policy, and Management. 2001, San Francisco, Jossey-Bass, 2

Central Bureau of Statistics, National Planning Commission Secretariat: Population Census. 2001, His Majesty Government, Nepal

UNICEF: Monitoring the situation of children and women Multiple Indicator Cluster Survey (MCIS-2). 2001, [http://www.unicef.org/uwwide/]

Ministry of Health His, Majesty Government: Annual Health Report-2002. 2002, His Majesty Government, Nepal

Niraula BB: Use of health services in hill villages in central Nepal. Health Transit Rev. 1994, 4 (2): 151-66.

Jimba M, Poudyal AK, Wakai S: The need for linking healthcare-seeking behavior and health policy in rural Nepal. Southeast Asian J Trop Med Public Health. 2003, 34 (2): 462-3.

Shankar PR, Kumar P, Theodore AM, Partha P, Shenoy N: A survey of drug use patterns in western Nepal. Singapore Med J. 2003, 44 (7): 352-6.

Shankar PR, Partha P, Shenoy N: A study on the use of complementary and alternative medicines therapies in and around Pokhara sub-metropolitan city, western Nepal. Journal of Nepal Health Research Council. 2003, 1 (2): 30-34.

Shankar PR, Partha P, Shenoy N: Self medication and non-doctor prescriptions practices in Pokhara valley, western Nepal: a questionnaire-based study. BMC Family Practice. 2002, 3: 17-10.1186/1471-2296-3-17.

International network for rational use of drugs (INRUD): Nepal 18 th National training course on rational use of drugs. Training Manual. 2005, Kathmandu, 15–20 April, 2005.

Neumark Y, Palti H, Donchin M, Ellencweig AY: Utilization of pediatric health services in Jerusalem. J Community Health. 1992, 17 (5): 271-82. 10.1007/BF01324357.

Pillai RK, Williams SV, Glick HA, Polsky D, Berlin JA, Lowe RA: Factors affecting decisions to seek treatment for sick children in Kerala, India. Soc Sci Med. 2003, 57 (5): 783-90. 10.1016/S0277-9536(02)00448-3.

Fosu GB: Childhood morbidity and health services utilization: cross-national comparisons of user-related factors from DHS data. Soc Sci Med. 1994, 38 (9): 1209-20. 10.1016/0277-9536(94)90186-4.

Kutty VR: Women's education and its influence on attitudes to aspects of child-care in a village community in Kerala. Soc Sci Med. 1989, 29 (11): 1299-303. 10.1016/0277-9536(89)90070-1.

Goldman N, Pebley AR, Gragnolati M: Choices about treatment for ARI and diarrhea in rural Guatemala. Soc Sci Med. 2002, 55 (10): 1693-712. 10.1016/S0277-9536(01)00260-X.

Herman E, Black RE, Wahba S, Khallaf N: Developing strategies to encourage appropriate care-seeking for children with acute respiratory infections: an example from Egypt. Int J Health Plann Manage. 1994, 9 (3): 235-43.

Pokhrel S, Snow R, Dong H, Hidayat B, Flessa S, Sauerborn R: Gender role and child health care utilization in Nepal. Health Policy. 2005, 74 (1): 100-9. 10.1016/j.healthpol.2004.12.013.

Pokhrel S, Sauerborn R: Household decision-making on child health care in developing countries: the case of Nepal. Health Policy Plan. 2004, 19 (4): 218-33. 10.1093/heapol/czh027.

Mohan P, Iyengar SD, Martines J, Cousens S, Sen K: Impact of counselling on care seeking behaviour in families with sick children: cluster randomized trial in rural India. BMJ. 329 (7460): 266-10.1136/bmj.38149.703380.47. 2004 Jul 31.