Barriers to healthcare access and healthcare seeking for childhood illnesses among childbearing women in sub-Saharan Africa: A multilevel modelling of Demographic and Health Surveys

Abstract

Introduction The success of current policies and interventions on providing effective access to treatment for childhood illnesses hinges on families’ decisions relating to healthcare access. In sub-Saharan Africa (SSA), there is an uneven distribution of child healthcare services. We investigated the role played by barriers to healthcare accessibility in healthcare seeking for childhood illnesses among childbearing women in SSA. Materials and methods Data on 223,184 children under five were extracted from Demographic and Health Surveys of 29 sub-Saharan African countries, conducted between 2010 and 2018. The outcome variable for the study was healthcare seeking for childhood illnesses. The data were analyzed using Stata version 14.2 for windows. Chi-square test of independence and a two-level multivariable multilevel modelling were carried out to generate the results. Statistical significance was pegged at p<0.05. We relied on ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) statement in writing the manuscript. Results Eighty-five percent (85.5%) of women in SSA sought healthcare for childhood illnesses, with the highest and lowest prevalence in Gabon (75.0%) and Zambia (92.6%) respectively. In terms of the barriers to healthcare access, we found that women who perceived getting money for medical care for self as a big problem [AOR = 0.81 CI = 0.78–0.83] and considered going for medical care alone as a big problem [AOR = 0.94, CI = 0.91–0.97] had lower odds of seeking healthcare for their children, compared to those who considered these as not a big problem. Other factors that predicted healthcare seeking for childhood illnesses were size of the child at birth, birth order, age, level of community literacy, community socio-economic status, place of residence, household head, and decision-maker for healthcare. Conclusion The study revealed a relationship between barriers to healthcare access and healthcare seeking for childhood illnesses in sub-Saharan Africa. Other individual and community level factors also predicted healthcare seeking for childhood illnesses in sub-Saharan Africa. This suggests that interventions aimed at improving child healthcare in sub-Saharan Africa need to focus on these factors.

Factors associated with healthcare seeking for childhood illnesses among mothers of children under five in Chad

“…Mothers who had the perception that their children were larger than average at birth were less likely to seek healthcare for childhood illnesses compared to those whose children had average size at birth. Similar findings have been obtained in previous studies in sub-Saharan Africa [ 38 , 40 ]. The authors are unable to provide reasons for this finding and consider this finding as a gap that should be explored in future studies since the size of the child at birth was obtained from the subjective opinion of mothers.…”

“…Finding on the association between community literacy level and healthcare seeking for childhood illnesses concurs with the findings of studies carried out in sub-Saharan Africa [ 37 , 38 ] and Ethiopia [ 39 ], where low community literacy among mothers was found to reduce healthcare seeking for childhood illnesses. The possible reason for the finding is that mothers who live in communities with high literacy levels are more likely to have access to all kinds of information on the need to seek care for their children’s diseases.…”

Impact of COVID-19 on Tuberculosis Case Detection and Treatment Outcomes in Sierra Leone

“…While these findings have been attributed largely to the direct effects of the COVID-19 lockdowns, Thakur et al and others [15][16][17] have suggested that other factors unrelated to the COVID-19 pandemic may be contributory. In Sierra Leone and other low-and middle-income countries (LMICs) in SSA, low health literacy rates; age-and gender-related differences in risk perception and care-seeking behavior; high out-of-pocket formal and informal costs of services; and transportation constraints are important barriers that commonly result in sub-optimal access and utilization of health services [20,21].…”

Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data

“…The variable who ultimately makes maternal care-seeking decisions was categorised as respondent (woman) alone, husband alone or joint decision. 51 Education was categorised as no education, primary education and secondary or higher. 52 Parity (number of children ever born) was categorised as primiparous (for first time mothers), para 2–3 (for those with two to three children) and para 4+.…”