Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
PLoS One. 2021 Aug 5;16(8):e0254885. doi: 10.1371/journal.pone.0254885. eCollection 2021.
Poor healthcare-seeking behaviour is a major contributing factor for increased morbidity and mortality among children in low- and middle-income countries. This study assessed the individual and community level factors associated with healthcare-seeking behaviour for childhood illnesses among mothers of children under five in Chad.
The study utilized data from the 2014-2015 Chad Demographic and Health Survey. A total of 5,693 mothers who reported that their children under five had either fever accompanied by cough or diarrhea or both within the two weeks preceding the survey were included in this study. The outcome variable for the study was healthcare-seeking behaviour for childhood illnesses. The data were analyzed using Stata version 14.2. Multilevel binary logistic regression model was employed due to the hierarchical nature of the dataset. Results were presented as adjusted odds ratios (aOR) at 95% confidence interval (CI).
Out of the 5,693 mothers who reported that their children under five had either fever accompanied by cough, diarrhea or both at any time in the 2 weeks preceding the survey, 79.6% recalled having sought treatment for their children's illnesses. In terms of the individual level factors, mothers who faced financial barriers to healthcare access were less likely to seek healthcare for childhood illnesses, relative to those who faced no financial barrier (aOR = 0.80, 95% CI = 0.65-0.99). Mothers who reported that distance to the health facility was a barrier were less likely to seek healthcare for childhood illnesses, compared to those who faced no geographical barrier to healthcare access (aOR = 79, 95% CI = 0.65-0.95). Mothers who were cohabiting were less likely to seek healthcare for childhood illnesses compared to married mothers (aOR = 0.62 95% CI = 0.47-0.83). Lower odds of healthcare seeking for childhood illnesses was noted among mothers who did not listen to radio at all, relative to those who listened to radio at least once a week (aOR = 0.71, 95% CI = 0.55-0.91). Mothers who mentioned that their children were larger than average size at birth had a lesser likelihood of seeking childhood healthcare, compared to those whose children were of average size (aOR = 0.79, 95% CI = 0.66-0.95). We further noted that with the community level factors, mothers who lived in communities with medium literacy level were less likely to seek childhood healthcare than those in communities with high literacy (aOR = 0.73, 95% CI = 0.53-0.99).
The study revealed that both individual (financial barriers to healthcare access, geographical barriers to healthcare access, marital status, frequency of listening to radio and size of children at birth) and community level factors (community level literacy) are associated with healthcare-seeking behaviour for childhood illnesses in Chad. The government of Chad, through multi-sectoral partnership, should strengthen health systems by removing financial and geographical barriers to healthcare access. Moreover, the government should create favourable conditions to improve the status of mothers and foster their overall socio-economic wellbeing and literacy through employment and education. Other interventions should include community sensitization of cohabiting mothers and mothers with children whose size at birth is large to seek healthcare for their children when they are ill. This can be done using radio as means of information dissemination.
在中低收入国家，儿童医疗保健服务利用不足是导致儿童发病率和死亡率上升的一个主要因素。本研究评估了乍得五岁以下儿童母亲在为儿童患病寻求医疗服务方面的个人和社区层面的因素。
本研究利用了 2014-2015 年乍得人口与健康调查的数据。共有 5693 名母亲报告称，她们五岁以下的孩子在调查前两周内曾出现过发烧伴有咳嗽、腹泻或两者兼有。本研究的因变量是儿童疾病的医疗服务利用情况。使用 Stata 14.2 版本进行数据分析。由于数据集具有层次结构，因此采用了多级二项逻辑回归模型。结果以 95%置信区间（CI）的调整比值比（aOR）表示。
在 5693 名报告其五岁以下孩子在调查前两周内曾出现过发烧伴有咳嗽、腹泻或两者兼有症状的母亲中，有 79.6%的人回忆说曾为孩子的疾病寻求过治疗。在个人层面的因素方面，与没有遇到医疗保健获取方面经济障碍的母亲相比，面临经济障碍的母亲为孩子的疾病寻求医疗服务的可能性较小（aOR=0.80，95%CI=0.65-0.99）。与没有地理障碍的母亲相比，报告距离医疗机构是障碍的母亲为孩子的疾病寻求医疗服务的可能性较小（aOR=0.79，95%CI=0.65-0.95）。与已婚母亲相比，同居的母亲为孩子的疾病寻求医疗服务的可能性较小（aOR=0.62，95%CI=0.47-0.83）。与每周至少听一次广播的母亲相比，根本不听广播的母亲为孩子的疾病寻求医疗服务的可能性较小（aOR=0.71，95%CI=0.55-0.91）。与孩子出生时体型正常的母亲相比，提到孩子出生时体型较大的母亲为孩子寻求医疗保健的可能性较小（aOR=0.79，95%CI=0.66-0.95）。我们还注意到，在社区层面的因素中，与生活在高识字率社区的母亲相比，生活在中等识字率社区的母亲为孩子寻求医疗保健的可能性较小（aOR=0.73，95%CI=0.53-0.99）。
本研究表明，个人层面的因素（医疗保健获取方面的经济障碍、医疗保健获取方面的地理障碍、婚姻状况、听广播的频率和孩子出生时的体型）和社区层面的因素（社区层面的识字率）都与乍得儿童疾病的医疗服务利用行为有关。乍得政府应通过多部门伙伴关系，加强卫生系统，消除医疗保健获取方面的经济和地理障碍。此外，政府应创造有利条件，通过就业和教育提高母亲的地位，促进她们的整体社会经济福利和识字率。其他干预措施包括对同居母亲和孩子出生时体型较大的母亲进行社区宣传，让她们在孩子生病时为孩子寻求医疗服务。这可以通过广播作为信息传播手段来实现。
