Department of Statistical Methods and Actual Science, School of Statistics and Planning, Makerere University, P.O.Box 7062, Kampala, Uganda.
BMC Pediatr. 2024 Jun 22;24(1):403. doi: 10.1186/s12887-024-04879-9.
Diarrhea is considered to be one of the major public health concerns in developing countries. It has a detrimental impact, reflecting one of the highest child mortality rates globally, especially in Sub-Saharan Africa, where 2 out of every 10 children in Uganda under the age of five die. The objective of this study was to investigate the factors associated with time to treatment seeking by caretakers of children under-five with Diarrhea in Uganda.
DOVE dataset of 745 caretakers in a prospective and retrospective incidence-based study using multi-stage sampling design was used in the assessment. The analysis was done using a time-to-event approach using life tables, Kaplan Meier survival analysis and multilevel proportional hazards model.
Kaplan-Meier survival analysis indicated the median time to seeking treatment among 745 caretakers of children under-Five after onset of diarrhea was 2 days. The multi-level proportional hazards model of a Weibull distribution showed that the estimated frailty variance was 0.13, indicating heterogeneity of treatment seeking time by caretakers of under-five children with diarrhea across regions in Uganda. Significant factors found to influence time to treatment-seeking by caretakers of children under-five with diarrhea were, male children (HR = 0.82; 95% CI = 0.71-0.95, p = 0.010), belonging to richest wealth quintile (HR = 1.37; 95% CI = 1.05-1.78, p = 0.022), and residing more than 5 km away from a health facility (HR = 0.68; 95% CI = 0.56-0.84, p = 0.000).
There are delays in seeking diarrhea treatment in Uganda because two days are enough to claim a life after dehydration.The policymakers should pay attention to formulate effective intervention to sensitize caregivers on the importance of early treatment-seeking behavior to avoid severe malnutrition caused by diarrhea. Community awareness program should also be encouraged particularly in areas of more than 5 km from the health facility to make people aware of the necessity to take prompt action to seek care in the early stage.
腹泻被认为是发展中国家主要的公共卫生问题之一。它具有破坏性影响，反映了全球最高的儿童死亡率之一，特别是在撒哈拉以南非洲，乌干达每 10 名五岁以下儿童中有 2 人死亡。本研究旨在调查乌干达五岁以下腹泻儿童看护人寻求治疗的时间相关因素。
使用多阶段抽样设计的前瞻性和回顾性基于发病率的研究中的 DOVE 数据集对 745 名看护人进行了评估。使用生存表、Kaplan-Meier 生存分析和多级比例风险模型进行时间事件分析。
Kaplan-Meier 生存分析表明，745 名五岁以下儿童腹泻发作后寻求治疗的中位数时间为 2 天。威布尔分布的多级比例风险模型显示，估计的脆弱性方差为 0.13，表明乌干达不同地区五岁以下腹泻儿童看护人寻求治疗的时间存在异质性。影响五岁以下腹泻儿童看护人寻求治疗时间的显著因素包括男童（HR=0.82；95%CI=0.71-0.95，p=0.010）、最富裕的五分之一财富阶层（HR=1.37；95%CI=1.05-1.78，p=0.022）和距离卫生机构超过 5 公里（HR=0.68；95%CI=0.56-0.84，p=0.000）。
乌干达在寻求腹泻治疗方面存在延迟，因为两天的时间足以导致脱水后死亡。政策制定者应注意制定有效的干预措施，使看护人认识到早期寻求治疗的重要性，以避免腹泻引起的严重营养不良。还应鼓励开展社区宣传计划，特别是在距离卫生机构超过 5 公里的地区，使人们认识到必须在早期阶段迅速采取行动寻求护理。
