School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
Department of Molecular Parasitology and Tropical Diseases, School of Medicine, Taipei Medical University, Taipei, Taiwan.
Am J Trop Med Hyg. 2019 Jun;100(6):1454-1465. doi: 10.4269/ajtmh.18-0900.
Early diagnosis and treatment of childhood fever, an important sign of potentially serious infections such as malaria, is essential for controlling disease progression, and ultimately, preventing deaths. This study examined individual- and community-level factors associated with treatment-seeking behaviors and promptness in these behaviors among caregivers of febrile under-five children in Malawi. The 2015-2016 Malawi Demographic Health Survey was used to analyze a nationally representative sample of 4,133 under-five children who had fever within 2 weeks before the survey. A multilevel logistic regression model was used to examine the association between individual- and community-level factors and treatment-seeking behaviors. Approximately 67.3% of the caregivers reported seeking treatment for their febrile child, whereas only 46.3% reported promptly seeking treatment. Children from communities with moderate and high percentages of educated caregivers were more likely to be taken for treatment (adjusted odds ratio [aOR] = 1.26, 95% CI = 1.01-1.58 and aOR = 1.31, 95% CI = 1.02-1.70, respectively) than those from communities with a low percentage of educated caregivers. Children from communities with moderate and high percentages of caregivers complaining about the distance to a health facility were less likely to be taken for treatment (aOR = 0.74, 95% CI = 0.58-0.96 and aOR = 0.67, 95% CI = 0.51-0.88, respectively). At the individual level, having a cough in the last 2 weeks, region, religion, and having better health behaviors in other health dimensions were associated with fever treatment-seeking behaviors among Malawian caregivers. Programs aimed at improving treatment-seeking behaviors should consider these factors and the regional variations observed in this study.
早期诊断和治疗儿童发热,这是疟疾等潜在严重感染的重要标志,对于控制疾病进展并最终预防死亡至关重要。本研究调查了马拉维 5 岁以下发热儿童照顾者寻求治疗行为及其及时性的个体和社区层面的因素。本研究使用 2015-2016 年马拉维人口健康调查的数据,分析了一个全国代表性的 4133 名 5 岁以下儿童的样本,这些儿童在调查前两周内有发热。使用多水平逻辑回归模型来检验个体和社区层面因素与治疗寻求行为之间的关联。大约 67.3%的照顾者报告为发热儿童寻求治疗,而只有 46.3%的照顾者报告及时寻求治疗。来自社区中受教育程度较高的照顾者比例中等和较高的儿童更有可能接受治疗(调整后的优势比[aOR]分别为 1.26,95%置信区间[CI]为 1.01-1.58 和 aOR = 1.31,95%CI = 1.02-1.70),而来自受教育程度较低的社区的儿童则不太可能接受治疗。来自社区中抱怨到医疗机构距离较远的照顾者比例中等和较高的儿童更不可能接受治疗(aOR 分别为 0.74,95%CI 为 0.58-0.96 和 aOR = 0.67,95%CI = 0.51-0.88)。在个体层面上,过去 2 周内有咳嗽、地区、宗教信仰以及在其他健康维度中有更好的健康行为与马拉维照顾者的发热治疗寻求行为相关。旨在改善治疗寻求行为的项目应考虑这些因素以及本研究中观察到的区域差异。
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