Caregiver Decision-Making: Household Response to Child Illness in Sub-Saharan Africa

Abstract

We draw upon a framework outlining household recognition and response to child illness proposed by Colvin and colleagues (2013) to examine factors predictive of treatment sought for a recent child illness. In particular, we model whether no treatment, middle layer treatment (traditional healer, pharmacy, community health worker, etc.), or biomedical treatment was sought for recent episodes of diarrhea, fever, or cough. Based on multinomial, multilevel analyses of Demographic and Health Surveys from 19 countries in sub-Saharan Africa, we determine that if women have no say in their own healthcare, they are unlikely to seek treatment in response to child illness. We find that women in sub-Saharan Africa need healthcare knowledge, the ability to make healthcare decisions, as well as resources to negotiate cost and travel, in order to access biomedical treatment. Past experience with medical services such as prenatal care and a skilled birth attendant also increase the odds that biomedical treatment for child illness is sought. We conclude that caregiver decision-making in response to child illness within households is critical to reducing child morbidity and mortality in sub-Saharan Africa.

Effects of the Informed Health Choices podcast on the ability of parents of primary school children in Uganda to assess the trustworthiness of claims about treatment effects: one-year follow up of a randomised trial

“…Many people do not have the required aptitude to critically appraise the trustworthiness of claims about the effects of treatments, and often act on them in making choices about treatments [15][16][17][18][19][20][21][22][23][24]. Poorly informed health choices can result in overuse of ineffective or harmful treatments (actions intended to maintain or improve the health of individuals or communities), underuse of effective treatments, waste and unnecessary suffering [25][26][27][28][29]. Making well-informed choices about treatments is especially important in low-income countries, which have few resources to waste and where the repercussions for making poor health choices are likely to be greater [30][31][32][33][34].…”

Rural-urban disparities and factors associated with delayed care-seeking and testing for malaria before medication use by mothers of under-five children, Igabi LGA, Kaduna Nigeria

“…The health-seeking behaviour for febrile illness by mothers of U5 children is poor and not commensurate with high burden of fever and malaria in Nigeria, a country with highly favourable climatic conditions for malaria transmission [1,2,4,11,12,13]. The Nigeria Demographic Health Survey 2018 revealed that 29% of mothers with no education had the highest proportion of children with a fever in the previous two weeks [3] and six out of ten mothers sought treatment from private sectors, such as patent medicine vendors and pharmacists.…”

Rural-urban disparities and factors associated with delayed care seeking for fever by mothers of under-five children, Igabi LGA, Kaduna Nigeria.

“…Mothers' health seeking behaviour for febrile illness in U5 children is not commensurate with the high malaria burden in Nigeria, a country with favourable climatic conditions for malaria transmission [1,2,4,11,12]. Usually, mothers being the most-at-home in Nigeria take the rst step in seeking treatment for their febrile child [13]. The knowledge and perception of the causes of the fever, and fever as indicator of illness severity may contribute to mothers' decision on how, when, and where to seek treatment advice.…”

“…The Nigeria Demographic Health Survey 2018 revealed that 29% of mothers with no education had the highest proportion of children with a fever in the past 2 weeks [3] and six out of ten mothers sought advice from private sectors like patent medicine vendors and pharmacists. Additionally, home selfmedication is a common response of mothers to fever like in other high malaria endemic countries [6,13,11]. Therefore, several factors may in uence mothers to seek care or advice for fever within 48 hours of onset in U5 children.…”

“…Some of the factors in uencing mothers' seeking advice or treatment for fever are short duration of fever [1], the season (rainy season) of the fever which coincides with high prevalence of malaria, source of treatment [14], rapid recovery from fever, rural location, availability of community-based health workers at health facilities, availability of malaria commodities in the health facilities, mother's level of education, mothers knowledge and perception of fever and malaria [10,15], lack of money for transportation and other expenses to treat the fever, and the age and sex of the child [16], perception of the family decision maker, mothers' employment status [17], household size of less than four members [12], and hospital waiting time [13,[18][19][20][21]. These factors differ from one locality to another and within sub-populations.…”