Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
Department of Nursing, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
Malar J. 2023 Apr 13;22(1):124. doi: 10.1186/s12936-023-04509-2.
In Cameroon, malaria contributes significantly to the morbidity and mortality of children under 5 years old. In order to encourage adequate treatment-seeking in health facilities, user fee exemptions for malaria treatment have been instituted. However, many children are still brought to health facilities in the late stage of severe malaria. This study sought to determine the factors affecting the hospital treatment-seeking time of guardians of children under 5 years within the context of this user fee exemption.
This was a cross-sectional study conducted at three randomly selected health facilities of the Buea Health District. A pre-tested questionnaire was used to collect data on the treatment-seeking behaviour and time of guardians, as well as potential predictors of this time. Hospital treatment sought after 24 h of noticing symptoms was denoted as delayed. Continuous variables were described using medians while categorical variables were described using percentages. A multivariate regression analysis was used to determine the factors affecting malaria treatment-seeking time of guardians. All statistical tests were done at a 95% confidence interval.
Most of the guardians made use of pre-hospital treatments, with self-medication being practiced by 39.7% (95% CI 35.1-44.3%) of them. A total of 193 (49.5%) guardians delayed seeking treatment at health facilities. Reasons for delay included financial constraints and watchful waiting at home, during which guardians waited and hoped their child could get better without requiring medicines. Guardians with estimated monthly household incomes denoted as low/middle were significantly more likely (AOR 3.794; 95% CI 2.125-6.774) to delay seeking hospital treatment. The occupation of guardians was another significant determinant of treatment-seeking time (AOR 0.042; 95% CI 0.003-0.607). Also, guardians with tertiary education were less likely (AOR 0.315; 95% CI 0.107-0.927) to delay seeking hospital treatment.
This study suggests that despite user fee exemption, other factors such as educational and income levels of guardians affect malaria treatment-seeking time for children aged under five. Therefore, these factors should be considered when enacting policies aimed at increasing access of children to health facilities.
在喀麦隆，疟疾是导致 5 岁以下儿童发病和死亡的主要原因。为了鼓励儿童在出现症状后到医疗机构接受充分的治疗，当地已对疟疾治疗实行了费用减免政策。然而，许多儿童在疟疾症状发展到严重阶段后才被送往医疗机构。本研究旨在确定在实施费用减免政策的背景下，影响儿童监护人在医疗机构接受治疗的时间的因素。
本研究为横断面研究，在布埃亚地区的 3 所随机选定的卫生机构开展。采用经过预测试的问卷收集了监护人的治疗选择和时间以及可能影响该时间的因素的数据。出现症状后 24 小时内就诊被定义为延迟就诊。连续变量用中位数表示，分类变量用百分比表示。采用多变量回归分析确定影响监护人疟疾治疗寻求时间的因素。所有统计检验均在 95%置信区间内进行。
大多数监护人会选择在医疗机构外接受治疗，其中 39.7%（95%CI 35.1-44.3%）的监护人会选择自行用药。共有 193 名（49.5%）监护人在医疗机构就诊时出现延迟。延迟的原因包括经济限制和在家观察，在此期间，监护人等待并希望孩子无需用药就能好转。收入被认为处于中下水平的监护人更有可能（AOR 3.794；95%CI 2.125-6.774）延迟寻求医疗机构的治疗。监护人的职业也是影响治疗寻求时间的一个重要决定因素（AOR 0.042；95%CI 0.003-0.607）。此外，接受过高等教育的监护人不太可能（AOR 0.315；95%CI 0.107-0.927）延迟寻求医疗机构的治疗。
本研究表明，尽管实行了费用减免政策，但监护人的教育和收入等其他因素仍会影响 5 岁以下儿童的疟疾治疗寻求时间。因此，在制定旨在增加儿童获得医疗机构服务机会的政策时，应考虑这些因素。
