Taffa Negussie, Chepngeno G
African Population and Health Research Center, Nairobi, Kenya.
Trop Med Int Health. 2005 Mar;10(3):240-5. doi: 10.1111/j.1365-3156.2004.01381.x.
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.
采取适当的就医行为对于减少儿童严重及危及生命疾病的发生具有巨大潜力。我们评估了社会人口学、经济和疾病相关因素对肯尼亚内罗毕贫民窟居民为患病儿童寻求医疗服务的影响。对内罗毕城市人口监测系统（NUDSS）进行的一轮调查收集了有关两周内儿童发病率、疾病症状、感知到的疾病严重程度以及现代医疗服务使用情况的信息。在这轮数据收集期间，访谈人员共走访了15174户家庭，其中居住着3015名5岁以下儿童。在报告生病的999名（33.1%）儿童中，有604名（60.5%）寻求了某种形式的医疗护理。未外出就医的主要原因是资金短缺（49.6%）以及认为疾病不严重（28.1%）。在最年幼的年龄组（0 - 11个月）中，患病儿童寻求医疗服务的情况最为常见。看护人因腹泻症状寻求医疗护理的频率高于咳嗽症状，当腹泻伴有发烧时更是如此。对疾病严重程度的认知与寻求医疗服务密切相关。家庭收入在达到一定阈值水平之前与寻求医疗服务显著相关，超过该阈值后其影响趋于稳定。提高看护人识别儿童疾病危险信号的技能可能会增强就医行为。儿童疾病综合管理（IMCI）项目必须对城市贫困人口免费提供，以便增加医疗服务的寻求并改善儿童生存状况。
