Pierce Hayley, Gibby Ashley Larsen, Forste Renata
Department of Demography and Sociology, 2232 Piedmont Ave, University of California, Berkeley, Berkeley, CA 94720,
Department of Sociology, 512 Oswald Tower, Penn State University, State College, Pennsylvania, 16801,
Popul Res Policy Rev. 2016 Oct;35(5):581-597. doi: 10.1007/s11113-016-9396-y. Epub 2016 Jul 4.
We draw upon a framework outlining household recognition and response to child illness proposed by Colvin and colleagues (2013) to examine factors predictive of treatment sought for a recent child illness. In particular, we model whether no treatment, middle layer treatment (traditional healer, pharmacy, community health worker, etc.), or biomedical treatment was sought for recent episodes of diarrhea, fever, or cough. Based on multinomial, multilevel analyses of Demographic and Health Surveys from 19 countries in sub-Saharan Africa, we determine that if women have no say in their own healthcare, they are unlikely to seek treatment in response to child illness. We find that women in sub-Saharan Africa need healthcare knowledge, the ability to make healthcare decisions, as well as resources to negotiate cost and travel, in order to access biomedical treatment. Past experience with medical services such as prenatal care and a skilled birth attendant also increase the odds that biomedical treatment for child illness is sought. We conclude that caregiver decision-making in response to child illness within households is critical to reducing child morbidity and mortality in sub-Saharan Africa.
我们借鉴了科尔文及其同事（2013年）提出的一个框架，该框架概述了家庭对儿童疾病的认知和应对措施，以此来研究近期儿童疾病寻求治疗的预测因素。具体而言，我们构建模型，以分析对于近期出现的腹泻、发烧或咳嗽症状，是未寻求治疗、采用中间层治疗方式（传统治疗师、药店、社区卫生工作者等）还是生物医学治疗。基于对撒哈拉以南非洲19个国家的人口与健康调查的多项、多层次分析，我们确定，如果女性在自身医疗保健方面没有发言权，她们就不太可能因应儿童疾病而寻求治疗。我们发现，撒哈拉以南非洲的女性需要医疗保健知识、做出医疗保健决策的能力，以及用于协商费用和交通的资源，以便获得生物医学治疗。过去接受产前护理和有熟练接生员等医疗服务的经历，也会增加寻求儿童疾病生物医学治疗的几率。我们得出结论，家庭中照顾者针对儿童疾病的决策对于降低撒哈拉以南非洲儿童的发病率和死亡率至关重要。
