Fekadu Hailu, Mekonnen Wubegzier, Adugna Aynalem, Kloos Helmut, Hailemariam Damen
Department of Public Health, Arsi University College of Health Science, Assela, Ethiopia.
School of Public Health, Addis Ababa University College of Health Science, Addis Ababa, Ethiopia.
PLoS One. 2025 Apr 1;20(4):e0318651. doi: 10.1371/journal.pone.0318651. eCollection 2025.
Ethiopia is one of the developing countries with the highest inequity in the healthcare seeking behavior for under-five children. Despite this fact, not much is known about the trend of inequity, in healthcare seeking-behavior for symptoms of diarrhea, fever and acute respiratory infections (ARIs) among under-five children.
This study aimed to measure trends of inequity in healthcare seeking -behavior for diarrhea, fever, and ARI symptoms and its determinant factors among under-five children in Ethiopia.
Data from 2000, 2005, 2011, and 2016 Ethiopian Demographic and Health Surveys (EDHSs) were analyzed using the 2019 updated version of the WHO's Health Equity Assessment Toolkit (HEAT) software. Five equity dimensions were used to disaggregate datasets on healthcare seeking behavior for diarrhea, fever, and ARI symptoms: Based on wealth status, education, place of residence, sex of the child and administrative regions. Second, summary measures such as: equity gaps, equity ratios, population attributable fraction (PAF), population attributable Risk (PAR), absolute concentration index (ACI) and relative concentration index (RCI), was used. The concentration curve and horizontal inequity indices were used to evaluate the wealth-related disparities. To measure the determinants a multilevel logistic regression with 95% confidence interval was employed.
This study showed remarkable improvement in healthcare seeking behavior for symptoms of diarrhea, fever and ARI among under-five children between 2000 and 2016. The increases are more, from the poorest subgroups compared to the wealthiest. The absolute percentage point changes (or healthcare seeking rate changes) between 2000 and 2016 among the poorest quintile of households are at least twice that of the wealthiest quintile for symptoms of diarrhea. However, significant disparities between the rich and the poor persist for the majority of the indicators examined for the three childhood morbidities. Moreover, horizontal inequity indices and the concentration curve both point out to the existence of pro-rich inequity in healthcare seeking behavior for under five children. In the multilevel analysis various demographic, parental and household characteristic show an association with healthcare seeking behavior for symptoms of diarrhea, fever and ARIs.
A promising trend is observed in healthcare seeking behavior for diarrhea, fever and ARI symptoms among under-five children. Faster progress in use of healthcare services among the poor than the wealthy in Ethiopia would potentially result in elimination of inequities and rapid improvement in health among the poor. Intervention programs that focused on the underprivileged, while also taking into account the wealthier sub-groups.
埃塞俄比亚是五岁以下儿童医疗保健寻求行为不公平程度最高的发展中国家之一。尽管如此，关于五岁以下儿童腹泻、发烧和急性呼吸道感染（ARI）症状的医疗保健寻求行为的不公平趋势，人们了解得并不多。
本研究旨在衡量埃塞俄比亚五岁以下儿童腹泻、发烧和ARI症状的医疗保健寻求行为的不公平趋势及其决定因素。
使用世界卫生组织（WHO）2019年更新版的健康公平评估工具包（HEAT）软件，分析了2000年、2005年、2011年和2016年埃塞俄比亚人口与健康调查（EDHS）的数据。使用五个公平维度对腹泻、发烧和ARI症状的医疗保健寻求行为数据集进行分类：基于财富状况、教育程度、居住地点、儿童性别和行政区。其次，使用了诸如公平差距、公平比率、人群归因分数（PAF）、人群归因风险（PAR）、绝对集中指数（ACI）和相对集中指数（RCI）等汇总指标。使用集中曲线和横向不公平指数来评估与财富相关的差异。为了衡量决定因素，采用了具有95%置信区间的多水平逻辑回归。
本研究表明，2000年至2016年间，五岁以下儿童腹泻、发烧和ARI症状的医疗保健寻求行为有显著改善。与最富裕的亚组相比，最贫穷的亚组改善幅度更大。2000年至2016年间，最贫穷五分位数家庭中腹泻症状的绝对百分点变化（或医疗保健寻求率变化）至少是最富裕五分位数家庭的两倍。然而，在所研究的三种儿童疾病的大多数指标上，贫富之间的显著差距仍然存在。此外，横向不公平指数和集中曲线都指出，五岁以下儿童的医疗保健寻求行为中存在有利于富人的不公平现象。在多水平分析中，各种人口、父母和家庭特征与腹泻、发烧和ARI症状的医疗保健寻求行为相关。
五岁以下儿童腹泻、发烧和ARI症状的医疗保健寻求行为呈现出良好的趋势。在埃塞俄比亚，穷人比富人更快地利用医疗服务，这可能会消除不公平现象，并使穷人的健康状况迅速改善。干预项目应侧重于弱势群体，同时也要考虑到较富裕的亚组。
