title: Improvement in mothers' immediate care-seeking behaviors for children's danger signs through a community-based intervention in Lusaka, Zambia.
abstract: The large number of child deaths in developing countries is associated with delays in care-seeking by families, but the community-based efforts of the Integrated Management of Childhood Illnesses developed by WHO/UNICEF has remained ineffectual. To improve caregivers' ability to recognise potentially life-threatening symptoms of major childhood illnesses, we provided education about the importance of danger signs and immediate care-seeking practices through a community-based intervention of 'the Growth Monitoring Programme Plus (GMP+)' in low-income areas of Lusaka, Zambia. Using repeated cross-sectional data from interviews, we compared attendance and non-attendance groups to assess the impacts of intervention on mothers' care-seeking. Of 1717 and 1546 attendance mothers in the baseline and the final survey, 1097 and 1035, respectively, sought care from a health centre after perceiving the danger signs. The proportion of mothers with immediate response increased from 35.7% (392/1097) to 51.5% (533/1035) (p < 0.01). In the final survey, the attendance mothers became more likely to respond immediately to the danger signs than the non-attendance mothers (adjusted odds ratio: 2.140, 95% confidence interval: [1.408-3.252]), and the higher educational level the attendance mothers had, the more likely they were to respond immediately to the danger signs (primary level: 2.067 [1.050-4.068], secondary level and above: 2.174 [1.098-4.306]). In conclusion, GMP+ with danger sign education can improve mothers' care-seeking for severely sick children. Therefore, GMP+ has the potential to reduce child death in developing countries, i.e., contribute to the Millennium Development Goal 4 aiming at reducing child mortality by two-thirds by 2015.
authors.affiliation: Department of Infectious Disease Control, Division of Public Health, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Fujino
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sasaki
authors.forename: Kumiko
authors.initials: K
authors.lastname: Igarashi
authors.forename: Naohito
authors.initials: N
authors.lastname: Tanabe
authors.forename: Clara Mbwili
authors.initials: CM
authors.lastname: Muleya
authors.forename: Bushimbwa
authors.initials: B
authors.lastname: Tambatamba
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003153:Community Health Services; D003617:Dangerous Behavior; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008425:Maternal Behavior / Q000523:psychology*; D009035:Mothers; D013997:Time Factors; D015024:Zambia