Adane Metadel, Mengistie Bezatu, Mulat Worku, Kloos Helmut, Medhin Girmay
Ethiopian Institute of Water Resources (EIWR), Addis Ababa University, Addis Ababa, Ethiopia.
College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia.
J Health Popul Nutr. 2017 Apr 4;36(1):9. doi: 10.1186/s41043-017-0085-1.
Information on health-seeking behavior and utilization of health facilities in slums of Addis Ababa is scarce, impeding the implementation of effective interventions. The purpose of this study is to assess the status of health facilities utilization and predictors for health-seeking behavior of mothers/caregivers of under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia.
A community-based cross-sectional study design was employed in five rounds of surveys in seven kebeles in slums of Addis Ababa among 472 mothers/caregivers of 472 under-five children with acute diarrhea in reference to Andersen's behavioral model. Data were entered into EpiData Version 3.1 and analyzed using STATA Version 14.0. Descriptive statistics were used to examine patterns of health facilities utilization and multivariable logistic regression analysis was applied to identify predictors associated with health-seeking behavior.
Most mothers/caregivers (70.8%) sought care either at home (14.2%) or health facilities (56.6%), whereas 29.2% reported that they did not seek any care. Of those who consulted health facilities, government health facilities (76.9%) were more utilized than private (18.0%) and informal (5.1%) health facilities. Nearly all (93.9%) of the mothers/caregivers using government health facilities used health centers, and of those who took their children to private health facilities (60.9%) used clinics and 26.1% used pharmacies/drug vendors. Mothers/caregivers visiting health facilities obtained mainly oral rehydration salt (ORS) (39.8%) and home-recommended fluids (HRF) (40.3%), but few of them (11.9%) obtained ORS plus zinc supplementation. Predisposing factors of literacy of mothers/caregivers (adjusted odds ratio (AOR) = 2.4; 95% CI 1.4-4.1) and occupation (AOR = 2.6; 95% CI 1.5-4.6), the enabling factors of households monthly income of 50 United States Dollars (US$) and above (AOR = 2.9; 95% CI 1.5-5.6) and availability of nearest health facilities within 15 min walking distance (AOR = 3.3; 95% CI 1.7-6.6), and the need factors of recognizing danger signs of fever (AOR = 4.3; 95% CI 2.4-7.6) and vomiting (AOR = 3.3; 95% CI 1.8-5.9) were significantly associated with health-seeking behavior.
Increasing the proximity of health facilities in slums and health education and socioeconomic development programs targeting illiterate mothers/caregivers and poor households may promote and increase health-seeking behavior and the accessibility of health facilities for the treatment of acute diarrhea in under-five children in Addis Ababa slums.
亚的斯亚贝巴贫民窟居民的就医行为及卫生设施利用情况的相关信息匮乏，这阻碍了有效干预措施的实施。本研究旨在评估埃塞俄比亚亚的斯亚贝巴贫民窟中五岁以下急性腹泻儿童的母亲/照料者对卫生设施的利用状况以及就医行为的预测因素。
采用基于社区的横断面研究设计，参照安德森行为模型，在亚的斯亚贝巴贫民窟的七个社区进行了五轮调查，调查对象为472名五岁以下急性腹泻儿童的472名母亲/照料者。数据录入EpiData 3.1版本，并使用STATA 14.0版本进行分析。描述性统计用于研究卫生设施利用模式，多变量逻辑回归分析用于确定与就医行为相关的预测因素。
大多数母亲/照料者（70.8%）选择在家中（14.2%）或卫生设施（56.6%）寻求治疗，而29.2%的人表示他们未寻求任何治疗。在那些咨询过卫生设施的人中，政府卫生设施（76.9%）的利用率高于私立卫生设施（18.0%）和非正式卫生设施（5.1%）。几乎所有（93.9%）使用政府卫生设施的母亲/照料者都选择了卫生中心，而在那些带孩子去私立卫生设施的人中，60.9%的人选择了诊所，26.1%的人选择了药店/药品供应商。前往卫生设施就诊的母亲/照料者主要获得了口服补液盐（ORS）（39.8%）和家庭推荐液体（HRF）（40.3%），但只有少数人（11.9%）获得了ORS加锌补充剂。母亲/照料者的识字率（调整优势比（AOR）=2.4；95%置信区间1.4 - 4.1）和职业（AOR = 2.6；95%置信区间1.5 - 4.6）等 predisposing因素、家庭月收入50美元及以上（AOR = 2.9；95%置信区间1.5 - 5.6）和在步行15分钟距离内有最近的卫生设施（AOR = 3.3；95%置信区间1.7 - 6.6）等 enabling因素以及认识到发烧（AOR = 4.3；95%置信区间2.4 - 7.6）和呕吐（AOR = 3.3；95%置信区间1.8 - 5.9）等危险信号的需求因素与就医行为显著相关。
增加贫民窟卫生设施的可及性，以及针对文盲母亲/照料者和贫困家庭的健康教育及社会经济发展项目，可能会促进并增加亚的斯亚贝巴贫民窟五岁以下儿童急性腹泻治疗的就医行为和卫生设施的可及性。
