CIET Trust, 71 Oxford Road, Saxonwold, Johannesburg, 2196 South Africa.
CIET/PRAM, Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montreal, QC H3Z 1Z1 Canada.
Infect Dis Poverty. 2015 Jan 2;4(1):1. doi: 10.1186/2049-9957-4-1. eCollection 2015.
Poor children have a higher risk of contracting malaria and may be less likely to receive effective treatment. Malaria is an important cause of morbidity and mortality in Nigerian children and many cases of childhood fever are due to malaria. This study examined socioeconomic factors related to taking children with fever for treatment in formal health facilities.
A household survey conducted in Bauchi and Cross River states of Nigeria asked parents where they sought treatment for their children aged 0-47 months with severe fever in the last month and collected information about household socio-economic status. Fieldworkers also recorded whether there was a health facility in the community. We used treatment of severe fever in a health facility to indicate likely effective treatment for malaria. Multivariate analysis in each state examined associations with treatment of childhood fever in a health facility.
43% weighted (%wt) of 10,862 children had severe fever in the last month in Cross River, and 45%wt of 11,053 children in Bauchi. Of these, less than half (31%wt Cross River, 44%wt Bauchi) were taken to a formal health facility for treatment. Children were more likely to be taken to a health facility if there was one in the community (OR 2.31 [95% CI 1.57-3.39] in Cross River, OR 1.33 [95% CI 1.0-1.7] in Bauchi). Children with fever lasting less than five days were less likely to be taken for treatment than those with more prolonged fever, regardless of whether there was such a facility in their community. Educated mothers were more likely to take children with fever to a formal health facility. In communities with a health facility in Cross River, children from less-poor households were more likely to go to the facility (OR 1.30; 95% CI 1.07-1.58).
There is inequity of access to effective malaria treatment for children with fever in the two states, even when there is a formal health facility in the community. Understanding the details of inequity of access in the two states could help the state governments to plan interventions to increase access equitably. Increasing geographic access to health facilities is needed but will not be enough.
贫困儿童感染疟疾的风险更高，且可能无法获得有效治疗。疟疾是尼日利亚儿童发病和死亡的一个重要原因，许多儿童发热都是由疟疾引起的。本研究旨在调查与带发热儿童到正规医疗机构就诊相关的社会经济因素。
在尼日利亚的包奇州和十字河流州进行了一项家庭调查，询问父母在上个月中，他们带 0-47 月龄患有严重发热的儿童去哪里就诊，并收集了有关家庭社会经济状况的信息。现场工作人员还记录了社区内是否有医疗机构。我们将在医疗机构治疗严重发热视为可能有效的疟疾治疗。在每个州，我们都采用多变量分析来研究与在医疗机构治疗儿童发热相关的因素。
在十字河流州，10862 名儿童中有 43%（加权%wt）在上个月出现严重发热，在包奇州，11053 名儿童中有 45%wt。其中，不到一半（十字河流州 31%wt，包奇州 44%wt）的儿童到正规医疗机构接受了治疗。如果社区内有医疗机构，儿童更有可能被送往医疗机构（十字河流州的比值比[OR]为 2.31[95%CI 1.57-3.39]，包奇州的 OR 为 1.33[95%CI 1.0-1.7]）。发热持续不到五天的儿童与发热时间较长的儿童相比，无论社区内是否有这样的医疗机构，接受治疗的可能性都较小。受教育程度较高的母亲更有可能带发热儿童到正规医疗机构就诊。在十字河流州，有医疗机构的社区中，来自较贫困家庭的儿童更有可能去该机构就诊（OR 1.30；95%CI 1.07-1.58）。
即使社区内有正规医疗机构，这两个州的发热儿童获得有效疟疾治疗的机会也存在不平等。了解这两个州获得机会不平等的具体情况，可能有助于州政府规划干预措施，以公平地增加获得机会。增加获得卫生设施的地理途径是必要的，但还不够。
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