Understanding factors influencing care seeking for sick children in Ebonyi and Kogi States, Nigeria.
Adolescent
Adult
Attitude to Health
Caregivers
/ psychology
Child
Child, Preschool
Decision Making
Diarrhea
/ therapy
Family Characteristics
Female
Focus Groups
Humans
Infant
Infant, Newborn
Malaria
/ therapy
Male
Nigeria
Parents
/ psychology
Patient Acceptance of Health Care
/ psychology
Pneumonia
/ therapy
Qualitative Research
Care seeking
Child health
Diarrhea
Fever
Gender
Malaria
Nigeria
Pneumonia
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
24 May 2020
24 May 2020
Historique:
received:
24
07
2019
accepted:
16
03
2020
entrez:
26
5
2020
pubmed:
26
5
2020
medline:
21
10
2020
Statut:
epublish
Résumé
Nigeria has one of the highest child mortality rates in the world, with an estimated 750,000 deaths annually among children under age five. The majority of these deaths are due to pneumonia, malaria, or diarrhea. Many parents do not seek sick-child care from trained, biomedical providers, contributing to this high rate of mortality. This qualitative study explores factors enabling or preventing parents from seeking care for sick under-five children in Nigeria's Kogi and Ebonyi states, including gender-related roles and social norms. Interviews were conducted with parents of sick under-five children and service providers, and focus group discussions were held with community leaders to assess how care-seeking behavior was influenced by four modes from the Colvin et al. conceptual framework for household decision-making and pathways to care. These include (1) caregivers' recognition and response to illness, (2) seeking advice and negotiating access within the family, (3) making use of community-based treatment options, and (4) accessing biomedical services. Parents were found to have a general understanding of illness symptoms but did not always attribute illness to biomedical causes. Intra-household decision-making processes were shaped by gender dynamics between men and women, and were found to have great effects on decisions to seek care. Use of traditional medicine and self-treatment were found to be common first steps in treatment before turning to the biomedical care system. Once the decision to seek biomedical care was taken, the route of seeking care varied between seeking care at chemists and then continuing to health facilities or starting with a health facility and then accessing prescriptions from a chemist. We conclude that care-seeking decisions do not follow a linear process; that intra-household decision-making processes particularly among parents should not be underestimated in addressing sick-child care seeking; and that, given the role of mothers as primary caregivers, their knowledge in illness recognition and agency in care-seeking decision-making, and seeking biomedical care, is deserving of future study.
Sections du résumé
BACKGROUND
BACKGROUND
Nigeria has one of the highest child mortality rates in the world, with an estimated 750,000 deaths annually among children under age five. The majority of these deaths are due to pneumonia, malaria, or diarrhea. Many parents do not seek sick-child care from trained, biomedical providers, contributing to this high rate of mortality.
METHODS
METHODS
This qualitative study explores factors enabling or preventing parents from seeking care for sick under-five children in Nigeria's Kogi and Ebonyi states, including gender-related roles and social norms. Interviews were conducted with parents of sick under-five children and service providers, and focus group discussions were held with community leaders to assess how care-seeking behavior was influenced by four modes from the Colvin et al. conceptual framework for household decision-making and pathways to care. These include (1) caregivers' recognition and response to illness, (2) seeking advice and negotiating access within the family, (3) making use of community-based treatment options, and (4) accessing biomedical services.
RESULTS
RESULTS
Parents were found to have a general understanding of illness symptoms but did not always attribute illness to biomedical causes. Intra-household decision-making processes were shaped by gender dynamics between men and women, and were found to have great effects on decisions to seek care. Use of traditional medicine and self-treatment were found to be common first steps in treatment before turning to the biomedical care system. Once the decision to seek biomedical care was taken, the route of seeking care varied between seeking care at chemists and then continuing to health facilities or starting with a health facility and then accessing prescriptions from a chemist.
CONCLUSION
CONCLUSIONS
We conclude that care-seeking decisions do not follow a linear process; that intra-household decision-making processes particularly among parents should not be underestimated in addressing sick-child care seeking; and that, given the role of mothers as primary caregivers, their knowledge in illness recognition and agency in care-seeking decision-making, and seeking biomedical care, is deserving of future study.
Identifiants
pubmed: 32448259
doi: 10.1186/s12889-020-08536-5
pii: 10.1186/s12889-020-08536-5
pmc: PMC7245913
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
746Subventions
Organisme : USAID
ID : AID-OAA-A-14-00028
Références
J Health Popul Nutr. 2017 Jun 5;36(1):29
pubmed: 28583170
Soc Sci Med. 2010 Feb;70(3):360-367
pubmed: 19892453
Oman Med J. 2015 Sep;30(5):331-5
pubmed: 26421113
Afr J Reprod Health. 2007 Apr;11(1):76-89
pubmed: 17982950
Matern Child Health J. 2014 Jan;18(1):307-315
pubmed: 23576403
Lancet Glob Health. 2019 Jan;7(1):e47-e57
pubmed: 30497986
BMC Health Serv Res. 2016 Nov 21;16(1):669
pubmed: 27871282
PLoS One. 2014 Jun 27;9(6):e100038
pubmed: 24971642
Soc Sci Med. 2006 Jun;62(12):2945-59
pubmed: 16403595
Int Q Community Health Educ. 2005-2006;25(3):283-93
pubmed: 17686748
J Biosoc Sci. 2002 Jan;34(1):109-31
pubmed: 11814209
J Glob Health. 2014 Dec;4(2):020414
pubmed: 25520804
Malar J. 2014 Nov 21;13:447
pubmed: 25413231
Lancet. 2015 Dec 5;386(10010):2275-86
pubmed: 26361942
J Biosoc Sci. 2009 Jan;41(1):1-19
pubmed: 18549511
Soc Sci Med. 2013 Jun;86:66-78
pubmed: 23608095
Int Q Community Health Educ. 2005-2006;24(4):347-63
pubmed: 17686690
J Epidemiol Glob Health. 2016 Dec;6(4):303-313
pubmed: 27639039
Malar J. 2010 Dec 08;9:354
pubmed: 21143854
Lancet. 2012 Mar 31;379(9822):1225-33
pubmed: 22464386
PLoS One. 2015 Feb 23;10(2):e0117919
pubmed: 25706531
Int Health. 2012 Dec;4(4):289-94
pubmed: 24029675
Malar Res Treat. 2012;2012:954975
pubmed: 22363898
Afr J Prim Health Care Fam Med. 2017 May 29;9(1):e1-e9
pubmed: 28582991
PLoS One. 2017 May 31;12(5):e0178129
pubmed: 28562611
Malar J. 2005 Feb 21;4:13
pubmed: 15723706
Lancet. 2017 Dec 17;388(10063):3027-3035
pubmed: 27839855
Int J Infect Dis. 2012 Feb;16(2):e136-45
pubmed: 22197748
BMC Public Health. 2019 Aug 5;19(1):1048
pubmed: 31382931
BMC Res Notes. 2011 Jul 01;4:228
pubmed: 21722357
J Health Commun. 2018;23(1):80-90
pubmed: 29265915
J Community Health. 2014 Dec;39(6):1171-8
pubmed: 24729003
Malar J. 2009 Sep 24;8:219
pubmed: 19778433
J Biosoc Sci. 2013 Nov;45(6):743-59
pubmed: 23601075
Health Care Women Int. 2008 Sep;29(8):906-25
pubmed: 18726798
Infect Dis Poverty. 2015 Jan 02;4(1):1
pubmed: 25671126
PLoS One. 2014 Apr 09;9(4):e93427
pubmed: 24718483
Acta Trop. 2015 Dec;152:269-281
pubmed: 26259818