Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Johns Hopkins Center for Communication Programs, Baltimore, USA.
BMC Public Health. 2022 Aug 1;22(1):1460. doi: 10.1186/s12889-022-13862-x.
Ethiopia's National Malaria Control and Elimination Program aims to diagnose all suspected malaria cases within 24 h of fever onset and provide prompt treatment for confirmed cases. This study explored psychosocial factors associated with no-, delayed- and prompt- care-seeking among female caregivers of children under five years with fever in rural Ethiopia.
Household surveys were conducted from 2016-2019 among female caregivers (N = 479) of children under five years old with fever in Oromia; Amhara; Southern Nations, Nationalities, and Peoples Region (SNNPR); and Tigray. Prompt and delayed care-seeking were defined as seeking treatment within ≤ 24 h or > 24 h of symptom onset respectively. Contextual factors explored included sociodemographic factors, household supply of bed nets, exposure to health messages, and household vulnerability (a measure of financial access to food, shelter, schooling, and medical treatment). Ideational factors included psychosocial factors related to care-seeking (knowledge, self-efficacy, response efficacy, attitudes, involvement in decision-making, and household social support).
The prevalence of fever among children under five years was 18% (ranging from 9% in Tigray to 34% in SNNPR. Overall, 45% of caregivers of children with fever sought care promptly, while 23% delayed care-seeking and 32% sought no care. Prompt care-seeking rates were higher among caregivers with positive attitudes toward prompt care-seeking (48%), involved in decision-making (48%) or perceived equitable gender norms in the community (65%). Caregivers with a high care-seeking ideation had increased odds of prompt care-seeking (aOR: 2.65; 95% CI: 1.74-4.02). Significant contextual factors included residence in the Oromia region (aOR: 2.99; 95% CI:1.40-6.41), caregivers age 35-49 years (aOR: 0.49; 95% CI: 0.26-0.95), residence in vulnerable households (aOR: 2.01; 95% CI: 1.28-3.18).
Among this rural Ethiopian population, prompt care-seeking was low but positively influenced by both ideational and contextual psychosocial factors occurring at the caregiver level. Multi-sectoral interventions at the individual, community, and health facility levels are needed to improve prompt care-seeking. These include social behavior change interventions to improve ideation, complemented by health facility interventions to ensure provision of high-quality services and structural interventions to increase educational attainment in these rural settings.
埃塞俄比亚国家疟疾控制和消除计划旨在对所有发热病例在发病后 24 小时内进行诊断，并对确诊病例及时进行治疗。本研究探讨了与农村埃塞俄比亚五岁以下发热儿童女性照顾者无、延迟和及时寻求护理相关的社会心理因素。
2016-2019 年，在奥罗米亚、阿姆哈拉、南方各族人民民族州（SNNPR）和提格雷对 479 名五岁以下发热儿童的女性照顾者进行了家庭调查。及时和延迟寻求护理的定义分别为症状出现后≤24 小时或>24 小时内寻求治疗。探索的情境因素包括社会人口因素、家庭供应的蚊帐、接触健康信息以及家庭脆弱性（衡量获得食物、住所、教育和医疗的经济机会）。意念因素包括与寻求护理相关的社会心理因素（知识、自我效能、反应效能、态度、参与决策和家庭社会支持）。
五岁以下儿童发热的患病率为 18%（从提格雷的 9%到 SNNPR 的 34%不等）。总体而言，45%的发热儿童照顾者及时寻求护理，23%的人延迟寻求护理，32%的人不寻求护理。对及时寻求护理持积极态度（48%）、参与决策（48%）或认为社区性别规范公平（65%）的照顾者及时寻求护理的比例较高。具有较高护理意念的照顾者更有可能及时寻求护理（优势比：2.65；95%置信区间：1.74-4.02）。显著的情境因素包括居住在奥罗米亚地区（优势比：2.99；95%置信区间：1.40-6.41）、照顾者年龄 35-49 岁（优势比：0.49；95%置信区间：0.26-0.95）、居住在脆弱家庭（优势比：2.01；95%置信区间：1.28-3.18）。
在埃塞俄比亚农村地区，及时寻求护理的比例较低，但受到照顾者层面的意念和情境社会心理因素的积极影响。需要在个人、社区和医疗机构层面采取多部门干预措施，以改善及时寻求护理。这些干预措施包括改善意念的社会行为改变干预措施，辅以确保提供高质量服务的医疗机构干预措施，并增加这些农村地区的教育程度的结构性干预措施。
