Determinants and patterns of care-seeking for childhood illness in rural Pune District, India

Bibliographic Data

ID19552736
AuthorsAndrew Marsh (0000-0001-8845-3562, Johns Hopkins University, corresponding author), Siddhivinayak Hirve (0000-0002-9651-7789), Pallavi Lele, Uddhavi Chavan, Tathagata Bhattacharjee (0000-0001-9437-0894, Indepth Network), Harish Nair (0000-0002-9432-9100, University of Edinburgh), Sanjay Juvekar (0000-0002-7209-6924, Indepth Network), Harry Campbell (0000-0002-6169-6262, University of Edinburgh)
Year2020
Volume10
Issue1
Pages010601-010601
Publication date2020-06-01
Open AccessYes
TypeARTICLE
VenueJournal of Global Health (JOURNAL)
Journal identifiersISSN: 2047-2978 • E-ISSN: 2047-2986
PublisherInternational Society of Global Health (PUBLISHER • GB)
DOI10.7189/jogh.10.010601
PMID32082546
OpenAlexW3004718938
LanguageEN
Citations received1
References cited35

BACKGROUND: An estimated 1.2 million children under five years of age die each year in India, with pneumonia and diarrhea among the leading causes. Increasing care-seeking is important to reduce mortality and morbidity from these causes. This paper explores the determinants and patterns of care-seeking for childhood illness in rural Pune district, India. METHODS: Mothers having at least one child <5 years from the study area of the Vadu Health and Demographic Surveillance System were enrolled in a prospective cohort study. Household sociodemographic information was collected through a baseline questionnaire administered at enrollment. Participants were visited up to six times between July 2015 and February 2016 to collect information on recent childhood acute illness and associated care-seeking behavior. Multivariate logistic regression explored the associations between care-seeking and child, participant, and household characteristics. RESULTS: We enrolled 743 mothers with 1066 eligible children, completing 2585 follow-up interviews (90% completion). Overall acute illness prevalence in children was 26% with care sought from a health facility during 71% of episodes. Multivariable logistic regression showed care-seeking was associated with the number of reported symptoms (Odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.5-3.9) and household insurance coverage (OR = 2.2, 95% CI = 1.1-4.3). We observed an interaction between the associations of illness severity and maternal employment on care-seeking. Somewhat-to-very severe illness was associated with increased care-seeking among both employed (OR = 5.0, 95% CI = 2.2-11.1) and currently unemployed mothers (OR = 7.0, 95% CI = 3.9-12.6). Maternal employment was associated with reduced care-seeking for non-severe illness (OR = 0.3, 95% CI = 0.1-0.7), but not associated with care-seeking for somewhat-to-very severe illness. Child sex was not associated with care-seeking. CONCLUSIONS: This study demonstrates the importance of illness characteristics in determining facility-based care-seeking while also suggesting that maternal employment resulted in decreased care-seeking among non-severe illness episodes. The nature of the association between maternal employment and care-seeking is unclear and should be explored through additional studies. Similarly, the absence of male bias in care-seeking should be examined to assess for potential bias at other stages in the management of childhood illness

Confidence interval · Health care · Logistic regression · Odds ratio · Child Nutrition and Water Access · Demography · Global Maternal and Child Health · Medicine · Poverty, Education, and Child Welfare · Pediatrics

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