title: Access to a health facility and care-seeking for danger signs in children: before and after a community-based intervention in Lusaka, Zambia.
abstract: OBJECTIVE
  To assess the association of accessibility to a health facility with caregivers' care-seeking practices for children with danger signs before and after community-based intervention in Lusaka, Zambia.
  
  
  METHODS
  Health education on childhood danger signs was started in September 2003 at the monthly Growth Monitoring Program Plus (GMP+) service through various channels of health talk and one-on-one communication in a peri-urban area of Lusaka. Two repeated surveys were conducted: in 2003 to collect baseline data before the intervention and in 2006 for 3-year follow-up data. Caregivers who had perceived one or more danger signs in their children within 2 months of the surveys were eligible for the analysis. The association between appropriate and timely care-seeking practices and socio-demographic and socio-economic factors, attendance at community-based intervention and the distance to a health facility was examined with logistic regression analysis.
  
  
  RESULTS
  The percentage of caregivers immediately seeking care from health professionals increased from 56.1% (106/189) at baseline to 65.8% (148/225) at follow-up 3 years later (OR = 1.51, P < 0.05). Long distance to the health facility and low-household income negatively influenced caregivers' appropriate and timely care-seeking practices at baseline, but 3 years later, after the implementation of a community-based intervention, distance and household income were not significantly related to caregivers' care-seeking practices.
  
  
  CONCLUSIONS
  Poor accessibility to health facilities was a significant barrier to care-seeking in a peri-urban area. However, when caregivers are properly educated about danger signs and appropriate responses through community-based intervention, this barrier can be overcome through behavioural change in caregivers.
authors.affiliation: Department of Infectious Disease Control and International Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Japan. ssasaki@med.niigata-u.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sasaki
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Fujino
authors.forename: Kumiko
authors.initials: K
authors.lastname: Igarashi
authors.forename: Naohito
authors.initials: N
authors.lastname: Tanabe
authors.forename: Clara M
authors.initials: CM
authors.lastname: Muleya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D017028:Caregivers / Q000193:education / Q000523:psychology / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006266:Health Education / Q000592:standards; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D055815:Young Adult; D015024:Zambia