Kanté Almamy M, Gutierrez Hialy R, Larsen Anna M, Jackson Elizabeth F, Helleringer Stéphane, Exavery Amon, Tani Kassimu, Phillips James F
Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
Ifakara Health Institute, PO Box 78373, Dar es Salaam, Mikocheni, Tanzania.
BMC Public Health. 2015 Sep 23;15:951. doi: 10.1186/s12889-015-2264-6.
This paper identifies factors influencing differences in the prevalence of diarrhea, fever and acute respiratory infection (ARI), and health seeking behavior among caregivers of children under age five in rural Tanzania.
Using cross-sectional survey data collected in Kilombero, Ulanga, and Rufiji districts, the analysis included 1,643 caregivers who lived with 2,077 children under five years old. Logistic multivariate and multinomial regressions were used to analyze factors related to disease prevalence and to health seeking behavior.
One quarter of the children had experienced fever in the past two weeks, 12.0 % had diarrhea and 6.7 % experienced ARI. Children two years of age and older were less likely to experience morbidity than children under one year [ORfever = 0.77, 95 % CI 0.61-0.96; ORdiarrhea = 0.26, 95 % CI 0.18-0.37; ORARI = 0.60 95 % CI 0.41-0.89]. Children aged two and older were more likely than children under one to receive no care or to receive care at home, rather than to receive care at a facility [RRRdiarrhea = 3.47, 95 % CI 1.19-10.17 for "No care"]. Children living with an educated caregiver were less likely to receive no care or home care rather than care at a facility as compared to those who lived with an uneducated caregiver [RRRdiarrhea = 0.28, 95 % CI 1.10-0.79 for "No care"]. Children living in the wealthiest households were less likely to receive no care or home care for fever as compared to those who lived poorest households. Children living more than 1 km from health facility were more likely to receive no care or to receive home care for diarrhea rather than care at a facility as compared to those living less than 1 km from a facility [RRRdiarrhea = 3.50, 95 % CI 1.13-10.82 for "No care"]. Finally, caregivers who lived with more than one child under age five were more likely to provide no care or home care rather than to seek treatment at a facility as compared to those living with only one child under five.
Our results suggest that child age, caregiver education attainment, and household wealth and location may be associated with childhood illness and care seeking behavior patterns. Interventions should be explored that target children and caregivers according to these factors, thereby better addressing barriers and optimizing health outcomes especially for children at risk of dying before the age of five.
本文确定了影响坦桑尼亚农村地区五岁以下儿童腹泻、发烧和急性呼吸道感染（ARI）患病率差异以及照顾者就医行为的因素。
利用在基洛梅罗、乌朗加和鲁菲吉地区收集的横断面调查数据，分析纳入了1643名照顾者及其抚养的2077名五岁以下儿童。采用逻辑多元回归和多项回归分析与疾病患病率及就医行为相关的因素。
四分之一的儿童在过去两周内曾发烧，12.0%曾腹泻，6.7%曾患ARI。两岁及以上儿童的发病率低于一岁以下儿童[发烧的比值比（OR）=0.77，95%置信区间（CI）0.61 - 0.96；腹泻的OR = 0.26，95% CI 0.18 - 0.37；ARI的OR = 0.60，95% CI 0.41 - 0.89]。两岁及以上儿童比一岁以下儿童更有可能得不到护理或在家中接受护理，而非在医疗机构接受护理[腹泻的相对危险度比（RRR）=3.47，“未接受护理”的95% CI 1.19 - 10.17]。与未受过教育的照顾者抚养的儿童相比，由受过教育的照顾者抚养的儿童不太可能得不到护理或在家中接受护理，而是在医疗机构接受护理[腹泻的RRR = 0.28，“未接受护理”的95% CI 1.10 - 0.79]。与最贫困家庭的儿童相比，最富裕家庭的儿童发烧时得不到护理或在家中接受护理的可能性较小。与距离医疗机构不到1公里的儿童相比，距离医疗机构超过1公里的儿童腹泻时更有可能得不到护理或在家中接受护理，而非在医疗机构接受护理[腹泻的RRR = 3.50，“未接受护理”的95% CI 1.13 - 10.82]。最后，与只抚养一名五岁以下儿童的照顾者相比，抚养一名以上五岁以下儿童的照顾者更有可能不提供护理或在家中提供护理，而非带孩子去医疗机构治疗。
我们的结果表明，儿童年龄、照顾者教育程度、家庭财富和居住地点可能与儿童疾病及就医行为模式有关。应探索根据这些因素针对儿童和照顾者的干预措施，从而更好地消除障碍并优化健康结局，特别是对于有五岁前死亡风险的儿童。
