Understanding factors influencing care seeking for sick children in Ebonyi and Kogi States, Nigeria

Abstract

Background: Nigeria has one of the highest child mortality rates in the world, with an estimated 750,000 deaths annually among children under age five. The majority of these deaths are due to pneumonia, malaria, or diarrhea. Many parents do not seek sick-child care from trained, biomedical providers, contributing to this high rate of mortality. Methods: This qualitative study explores factors enabling or preventing parents from seeking care for sick underfive children in Nigeria's Kogi and Ebonyi states, including gender-related roles and social norms. Interviews were conducted with parents of sick under-five children and service providers, and focus group discussions were held with community leaders to assess how care-seeking behavior was influenced by four modes from the Colvin et al. conceptual framework for household decision-making and pathways to care. These include (1) caregivers' recognition and response to illness, (2) seeking advice and negotiating access within the family, (3) making use of community-based treatment options, and (4) accessing biomedical services. Results: Parents were found to have a general understanding of illness symptoms but did not always attribute illness to biomedical causes. Intra-household decision-making processes were shaped by gender dynamics between men and women, and were found to have great effects on decisions to seek care. Use of traditional medicine and self-treatment were found to be common first steps in treatment before turning to the biomedical care system. Once the decision to seek biomedical care was taken, the route of seeking care varied between seeking care at chemists and then continuing to health facilities or starting with a health facility and then accessing prescriptions from a chemist. Conclusion: We conclude that care-seeking decisions do not follow a linear process; that intra-household decisionmaking processes particularly among parents should not be underestimated in addressing sick-child care seeking; and that, given the role of mothers as primary caregivers, their knowledge in illness recognition and agency in careseeking decision-making, and seeking biomedical care, is deserving of future study.

Background predictors of time to death in infancy: evidence from a survival analysis of the 2018 Nigeria DHS data

“…Other predictors include region/geographic inequalities [19][20][21][22], age of mother (at first birth/current) [20,21] and health-seeking behavior for children, with the use of facility-based care for delivery and child illness leading to improved child survival [22][23][24][25]. Use of facility-based care is itself influenced by factors like location, education, socioeconomic status, and socio-cultural context [25][26][27][28][29][30].…”

Factors Influencing Caregivers’ Health Seeking Behavior for Malaria Treatment of Children Under 5 Years in Busia Municipality, Uganda

“…In Malawi and Tanzania, mothers prefer to rst treat their febrile child with antipyretics, and further manage the fever with tepid sponging, and then seek antimalaria drugs if the fever persists. Similarly, in Nigeria, malaria is not considered life-threatening, and mothers seek care at higher-level facilities when selftreatment has failed [14]. This trial-and-error process acts as a home-based diagnosis.…”

“…Since 2015, hospital admissions have remained almost constant within the country at 60% of the con rmed laboratory diseases [11]. The poor health-seeking behaviors related to malaria infection have been largely attributed to the low caregiver education, low economic status of the family members [14], low knowledge on malaria, low perceived malaria severity, increased belief in traditional care [17], negative experiences with the healthcare facilities [8], and unavailability of the required health services in the nearby health facilities [9]. Given these factors, more than 60% of all suspected malaria cases are treated outside the formal health sector, making the projected number of malaria cases to be as high as 60million per annum [5].…”

Factors affecting mothers’ intentions to visit healthcare facilities before hospitalisation of children with pneumonia in Biliran province, Philippines: a qualitative study

“…Mothers are usually the first to identify illness symptoms in the child; 52 however, caregivers' knowledge was not always positively associated with care-seeking behaviour. 53 As care-seeking decisions do not follow a linear process, 54 such advice from healthcare staff may function as a subjective norm for mothers' intention to visit a hospital.…”