Gender bias in careseeking practices in 57 low– and middle–income countries

Abstract

BackgroundPreventive and curative medical interventions can reduce child mortality. It is important to assess whether there is gender bias in access to these interventions, which can lead to preferential treatment of children of a given sex.MethodsData from Demographic and Health Surveys carried out in 57 low– and middle–income countries were used. The outcome variable was a composite careseeking indicator, which represents the proportion of children with common childhood symptoms or illnesses (diarrhea, fever, or suspected pneumonia) who were taken to an appropriate provider. Results were stratified by sex at the national level and within each wealth quintile. Ecological analyses were carried out to assess if sex ratios varied by world region, religion, national income and its distribution, and gender inequality indices. Linear multilevel regression models were used to estimate time trends in careseeking by sex between 1994 and 2014.FindingsEight out of 57 countries showed significant differences in careseeking; in six countries, girls were less likely to receive care (Colombia, Egypt, India, Liberia, Senegal and Yemen). Seven countries had significant interactions between sex and wealth quintile, but the patterns varied from country to country. In the ecological analyses, lower careseeking for girls tended to be more common in countries with higher income concentration (P = 0.039) and higher Muslim population (P = 0.006). Coverage increased for both sexes; 0.95 percent points (pp) a year among girls (32.9% to 51.9%), and 0.91 pp (34.8% to 52.9%) among boys.ConclusionThe overall frequency of careseeking is similar for girls and boys, but not in all countries, where there is evidence of gender bias. A gender perspective should be an integral part of monitoring, accountability and programming. Countries where bias is present need renewed attention by national and international initiatives, in order to ensure that girls receive adequate care and protection.

Gender bias in under-five mortality in low/middle-income countries

“…In an earlier set of analyses, we estimated gender bias in care-seeking for common childhood illnesses or symptoms, based on the same DHS data sets used in the present analyses. 11 Significant differences in care-seeking for sick boys and girls were not observed in most countries. However, we found evidence of gender bias in four countries that were also identified in the present set of analyses with significant excess female U5MR: India, Egypt, Liberia and Yemen.…”

“…We used the same data sets to calculate a composite care-seeking indicator which represents the proportion of children with any of these conditions who were taken to an appropriate provider. 11 This was estimated separately for girls and boys in each survey, and the sex ratio was calculated dividing the proportion of girls by the proportion of boys taken to an appropriate healthcare provider.…”

“…Based on results from a previous analysis of care-seeking from appropriate healthcare providers in the same countries, we also assess whether countries with excess female mortality present evidence of gender bias in care-seeking. 11 …”

Safety profile of the RTS,S/AS01 malaria vaccine in infants and children: additional data from a phase III randomized controlled trial in sub-Saharan Africa

“…The increased risk for mortality in RTS,S/AS01-vaccinated girls could be the result of the observed low female mortality rate in the control arm, which at 1.3% was lower than the mortality rate in all other study arms, both male and female. We do not have data from the trial on gender-specific parental care-seeking behaviors, 42 which might have confounded these gender-specific mortality outcomes.…”

Comparison of Health Service Utilization for Febrile Children Before and After Introduction of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy in Rural Papua New Guinea

“…The result was in accordance with the economic hypothesis mentioned above. However, recent analysis in 57 low- and middle-income countries reported that the proportion of utilization of health facilities for common illness of children was similar for boys and girls ( 34 ). In only two countries (Haiti and Uganda), females were more likely to be taken to health facilities, although the result from PNG was not included in the study.…”