Sources of Health Care Among Under-5 Malawian Children With Diarrhea Episodes: An Analysis of the 2017 Demographic and Health Survey

Abstract

Diarrhea is a leading cause of morbidity and mortality in the world but mostly in Sub-Saharan Africa. These could be prevented if universal coverage of current available interventions were implemented. The study aimed to identify factors associated with the choice of health care source among caretakers seeking treatment for under-5 children with diarrhea illness. Using women’s questionnaire we extracted a subset of data of children aged 0 to 59 months from the 2017 Demographic & Health Survey. Questions regarding history of childhood diarrhea for the past 24 hours or last 2 weeks prior to the survey were key in data extraction. Caregivers were asked to report the place where they sought treatment. In this study, 4 types of health facilities were defined: public, private, pharmacies, and other unspecified sources. A multinomial logistic regression model was used to identify sources of health facility used and corresponding factors associated with the choice. Factors associated with choice of health care source included education (educated women were less likely to self-medicate their children [relative risk ration (RRR) = 0.46; 95% confidence interval (CI) = 0.22-0.94]), income (better income earning families were more likely to seek care from private facility such as pharmacy [RRR = 1.87; 95% CI = 1.14-3.09]), and rural living (those in rural areas were more likely to seek treatment from other unspecified sources [RRR = 7.33, 95% CI = 1.40-38.36]). Public health facilities (79.9%) were the main source of health care service; however, reducing under-5 mortality due to diarrhea illness would require significant efforts to address other inequalities in accessing and utilizing health care services.

Prevalence and risk factors associated with under-five years children diarrhea in Malawi: Application of survey logistic regression

“…Such a finding is supported by Ref. [ 46 ]. Furthermore, my study did not find a significant association between the ethnicity of the household and diarrhea of under-five children.…”

Decomposing socio-economic inequality in catastrophic out-of-pocket health expenditures in Malawi

“…This is also supported by PLOS GLOBAL PUBLIC HEALTH our finding in Table 2 which indicates that access to private health facility is more concentrated among the better-off. Furthermore, other studies have shown that the use of health care services and out-of-pocket health expenditures are more concentrated among the better-off households in Malawi [22,37]. This high out-of-pocket health expenditures among the betteroff increase the likelihood of incurring catastrophic health expenditures.…”

Health care seeking behaviour for children with acute childhood illnesses and its relating factors in sub-Saharan Africa: evidence from 24 countries

“…There is evidence that at least one child dies out of every 12 births in sub-Saharan Africa before age five compared to one out of every 147 in developed countries [ 3 ]. The majority of under-five mortality in sub-Saharan Africa is due to infectious and parasitic diseases, such as malaria, respiratory infections, meningitis and diarrhea [ 5 , 13 , 14 , 21 ]. Diarrhea, for instance, is a major cause of morbidity and mortality globally, as it accounts for 1.3 million deaths among children under-5 years of age each year [ 21 ].…”

“…The majority of under-five mortality in sub-Saharan Africa is due to infectious and parasitic diseases, such as malaria, respiratory infections, meningitis and diarrhea [ 5 , 13 , 14 , 21 ]. Diarrhea, for instance, is a major cause of morbidity and mortality globally, as it accounts for 1.3 million deaths among children under-5 years of age each year [ 21 ]. Although childhood illnesses can be managed efficiently in sub-Saharan Africa, evidence suggest poor health care seeking behaviour among mothers for childhood illnesses in the region [ 18 , 22 ].…”