Carter Emily D, Ndhlovu Micky, Munos Melinda, Nkhama Emmy, Katz Joanne, Eisele Thomas P
Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Chainama College of Health Sciences, Lusaka, Zambia.
J Glob Health. 2018 Jun;8(1):010602. doi: 10.7189/jogh.08.010602.
Accurate data on care-seeking for child illness are needed to improve public health programs and reduce child mortality. The accuracy of maternal report of care-seeking for child illness as collected through household surveys has not been validated.
A 2016 survey compared reported care-seeking against a gold-standard of health care provider documented care-seeking events among a random sample of mothers of children <5 years in Southern Province, Zambia. Enrolled children were assigned cards with unique barcodes. Seventy-five health care providers were given smartphones with a barcode reader and instructed to scan the cards of participating children seeking care at the source, generating an electronic record of the care-seeking event. Additionally, providers gave all caregivers accessing care for a child <5 years provider-specific tokens used to verify the point of care during the household survey. Reported care-seeking events were ascertained in each household using a questionnaire modeled off the Zambia Demographic and Health Survey (DHS) / Multiple Indicator Cluster Survey (MICS). The accuracy of maternal report of care-seeking behavior was estimated by comparing care-seeking events reported by mothers against provider-documented events.
Data were collected on 384 children with fever, diarrhea, and/or symptoms of ARI in the preceding 2 weeks. Most children sought care from government facilities or community-based agents (CBAs). We found high sensitivity (Rural: 0.91, 95% confidence interval CI 0.84-0.95; Urban: 0.98, 95% CI 0.92-0.99) and reasonable specificity (Rural: 0.71, 95% CI 0.57-0.82; Urban: 0.76, 95% CI 0.62-0.85) of maternal report of care-seeking for child illness by type of provider. Maternal report of any care-seeking and seeking care from a skilled provider had slightly higher sensitivity and specificity. Seeking care from a traditional practitioner was associated with lower odds of accurately reporting the event, while seeking care from a government provider was associated with greater odds of accurate report. The measure resulted in a slight overestimation of true care-seeking behavior in the study population.
Maternal report is a valid measure of care-seeking for child illness in settings with high utilization of public sector providers. The study findings were limited by the low diversity in care-seeking practices for child illness and the exclusion of shops.
为改进公共卫生项目并降低儿童死亡率，需要有关儿童疾病就医情况的准确数据。通过家庭调查收集的母亲报告的儿童疾病就医情况的准确性尚未得到验证。
2016年的一项调查将报告的就医情况与医疗服务提供者记录的就医事件的金标准进行了比较，该金标准来自赞比亚南部省份随机抽取的5岁以下儿童的母亲样本。为登记的儿童分配带有唯一条形码的卡片。75名医疗服务提供者配备了带有条形码阅读器的智能手机，并被指示在儿童就医源头扫描参与调查儿童的卡片，生成就医事件的电子记录。此外，医疗服务提供者给所有为5岁以下儿童寻求医疗服务的照料者提供特定于提供者的令牌，用于在家庭调查期间核实就医地点。使用仿照赞比亚人口与健康调查（DHS）/多指标类集调查（MICS）的问卷在每个家庭中确定报告的就医事件。通过比较母亲报告的就医事件与医疗服务提供者记录的事件来估计母亲报告的就医行为的准确性。
收集了前两周内384名患有发烧、腹泻和/或急性呼吸道感染症状儿童的数据。大多数儿童在政府机构或社区机构（CBA）寻求治疗。我们发现，按提供者类型划分，母亲报告的儿童疾病就医情况具有较高的敏感性（农村：0.91，95%置信区间CI 0.84 - 0.95；城市：0.98，95%CI 0.92 - 0.99）和合理的特异性（农村：0.71，95%CI 0.57 - 0.82；城市：0.76，95%CI 0.62 - 0.85）。母亲报告的任何就医情况以及向熟练提供者寻求治疗的敏感性和特异性略高。向传统从业者寻求治疗与准确报告该事件的几率较低相关，而向政府提供者寻求治疗与准确报告的几率较高相关。该测量方法导致对研究人群中真实就医行为的轻微高估。
在公共部门提供者利用率高的环境中，母亲报告是儿童疾病就医情况的有效测量方法。该研究结果受到儿童疾病就医行为多样性低以及排除商店的限制。
