Kananura Jean L, C Rono Betsy, S Phiri Kamija
Environmental health and disease control, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Nairobi County, Kenya.
environmental health and disease control, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Nairobi County, Kenya.
Open Res Eur. 2024 Dec 12;4:143. doi: 10.12688/openreseurope.18028.1. eCollection 2024.
Almost 10 million children under the age of five in Kenya, die due to fever-related diseases. In Busia, a county in Kenya, malaria accounts for 13% of all child fatalities under the age of five, a number higher than any other county. This study aimed to determine (a) proportion of appropriate health-seeking behavior and (b) determinants of health-seeking behaviors (HSBs) among their caregivers in Butula Sub-County, Busia County, as reported by the caregivers.
This cross-sectional mixed-method study included 271 caregivers, 11 community health volunteers, and health facility workers in Butula Sub-County. Systematic random sampling for participants and purposive sampling for key informants were used. A questionnaire collected the data that was analysed using frequency and percentages and logistic regression.
Around seventy percent of caregivers reported seeking care for a child's fever within 24 hours. Individual factors that caregivers reported to influence appropriate health-seeking HSB were unemployment (adjusted odds ratio (aOR) = 0.49, 95% CI: 0.217 - 0.593, p = 0.018), self-medication preference (aOR = 0.14, 95% CI: 0.054 - 0.363, p < 0.001), had atleast two children (aOR = 0.63, 95% CI: 0.425 - 0.937, p = 0.042), and confidence in identifying fever (aOR = 7.0, 95% CI: 2.200 - 22.439, p = 0.001). Health-system factors reported to influence HSBs were facility too far (aOR = 0.86, 95% CI: 0.526 - 0.914, p = 0.027), getting health education (aOR = 1.8, 95% CI: 1.201-4.122, p=0.015), and facility level (aOR = 4.4, 95% CI: 2.015 - 9.750, p < 0.001). Qualitative findings found health system factors related to HSB as stockouts, facility distance, and staff workload.
Employment, multiple children, preferences to self-medicate, confidence in fever identification, facility level, distance to facility, and education are ky factors affecting caregiver's HSB. Policy and practice efforts should focus on these significant individual and health system determinants for HSBs among caregivers of children under five with febrile illness.
肯尼亚近1000万5岁以下儿童死于与发烧相关的疾病。在肯尼亚的布西亚县，疟疾占5岁以下儿童死亡总数的13%，这一比例高于其他任何县。本研究旨在确定：（a）布西亚县布图拉次县儿童看护者中适当就医行为的比例；（b）看护者报告的就医行为的决定因素。
这项横断面混合方法研究纳入了布图拉次县的271名看护者、11名社区卫生志愿者和卫生机构工作人员。参与者采用系统随机抽样，关键信息提供者采用目的抽样。通过问卷调查收集数据，并使用频率、百分比和逻辑回归进行分析。
约70%的看护者报告在24小时内会为孩子的发烧症状寻求治疗。看护者报告的影响适当就医行为的个体因素包括失业（调整优势比（aOR）=0.49，95%置信区间：0.217 - 0.593，p = 0.018）、自我用药偏好（aOR = 0.14，95%置信区间：0.054 - 0.363，p < 0.001）、至少有两个孩子（aOR = 0.63，95%置信区间：0.425 - 0.937，p = 0.042）以及识别发烧的信心（aOR = 7.0，95%置信区间：2.200 - 22.439，p = 0.001）。报告的影响就医行为的卫生系统因素包括医疗机构距离过远（aOR = 0.86，95%置信区间：0.526 - 0.914，p = 0.027）、接受健康教育（aOR = 1.8，95%置信区间：1.201 - 4.122，p = 0.015）以及医疗机构级别（aOR = 4.4，95%置信区间：2.015 - 9.750，p < 0.001）。定性研究结果发现，与就医行为相关的卫生系统因素包括药品缺货、医疗机构距离和工作人员工作量。
就业、孩子数量、自我用药偏好、识别发烧的信心、医疗机构级别、距离医疗机构的远近以及教育是影响看护者就医行为的关键因素。政策和实践应关注这些影响5岁以下发热疾病儿童看护者就医行为的重要个体和卫生系统决定因素。
