Journal Article

Household relationships and healthcare seeking behaviour for common childhood illnesses in sub-Saharan Africa: a cross-national mixed effects analysis

De Wet, Nicole, Akosile, Adenike E., Akinyemi, Joshua O., Banda, Pamela, Odimegwu, Clifford O.

2019

Overview

Background Intra-household dynamics play crucial roles in utilisation of healthcare services for children. We investigated the influence of household relationships on healthcare seeking behaviour for common childhood illnesses in four sub-Sahara African regions. Methods Data on 247,061 under-five children were extracted from recent Demographic and Health Surveys conducted between 2012 and 2016 in 25 countries. Data were combined and analysed per sub-region. Dependent variables (DVs) were uptake of health facility care for diarrhea and Acute Respiratory Tract Infection (ARI) symptoms. The main independent variable (IV) was household relationship which was represented by maternal marital profile (marital status, family type and number of marriages) and maternal relationship to household head. Mixed effects logit models were fitted to assess independent relationship between the IVs and DVs with adjustment for relevant demographic and socio-economic characteristics at 5% significance level. Results The percentage of children who received care for diarrhea and ARI symptoms from health facilities across sub-regions was: Western Africa (WA) 42.4, 44.1%; Central Africa (CA) 32.6, 33.9%; Eastern Africa (EA) 41.5, 48.7% and Southern Africa (SA) 58.9, 62.7%. Maternal marital profile was not associated with healthcare seeking behaviour for diarrhea and ARI symptoms in any of the sub-regions. Children whose mothers were daughter/daughter-in-law to household head were significantly less likely to be taken to health facility for diarrhea treatment in Eastern Africa (AOR = 0.81, CI: 0.51–0.95). Having a mother who is the head of household was significantly associated with higher odds of facility care for ARI symptoms for children from Western (AOR = 1.20, CI: 1.02–1.43) and Southern Africa (AOR = 1.49, CI: 1.20–1.85). Conclusion The type of relationship between mother of under-fives and head of households affect health seeking behaviour for treatment of diarrhea and ARI symptoms in Eastern, Western and Southern Africa. Countries in these regions need to adapt best practices for promoting healthcare utilisation for children such that household relationship does not constitute barriers.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Behavior / Best practices / Care and treatment / Child behavior / Child mortality / Childhood / Childhood illnesses / Children & youth / Childrens health / Clinical decision making / Decision making / Developing countries / Diarrhea / Families & family life / Family / Family context / Family relations / Gastrointestinal agents / Health Administration / Health care / Health care access / Health care industry / Health facilities / Health Informatics / Health services utilization / Health surveys / Health systems and services in low and middle income settings / Healthcare seeking behaviour / Healthcare utilisation / Household relationships / Households / Illnesses / Infection / Influenza / Investigations / LDCs / Marriage / Maternal & child health / Medical care utilization / Medicine / Medicine & Public Health / Monogamy / Mortality / Multilevel analysis / Nursing Research / Pediatric diseases / Pneumonia / Population / Public Health / Questionnaires / Research Article / Respiratory tract diseases / Rural areas / Social networks / Social structure / Sub-Saharan Africa / Womens health