title: Healthcare seeking for diarrhoea, malaria and pneumonia among children in four poor rural districts in Sierra Leone in the context of free health care: results of a cross-sectional survey.
abstract: BACKGROUND
  To plan for a community case management (CCM) program after the implementation of the Free Health Care Initiative (FHCI), we assessed health care seeking for children with diarrhoea, malaria and pneumonia in 4 poor rural districts in Sierra Leone.
  
  
  METHODS
  In July 2010 we undertook a cross-sectional household cluster survey and qualitative research. Caregivers of children under five years of age were interviewed about healthcare seeking. We evaluated the association of various factors with not seeking health care by obtaining adjusted odds ratios and 95% confidence limits using a multivariable logistic regression model. Focus groups and in-depth interviews of young mothers, fathers and older caregivers in 12 villages explored household recognition and response to child morbidity.
  
  
  RESULTS
  The response rate was 93% (n=5951). Over 85% of children were brought for care for all conditions. However, 10.8% of those with diarrhoea, 36.5% of those with presumed pneumonia and 41.0% of those with fever did not receive recommended treatment. In the multivariable models, use of traditional treatments was significantly associated with not seeking outside care for all three conditions. Qualitative data showed that traditional treatments were used due to preferences for locally available treatments and barriers to facility care that remain even after FHCI.
  
  
  CONCLUSIONS
  We found high healthcare seeking rates soon after the FHCI; however, many children do not receive recommended treatment, and some are given traditional treatment instead of seeking outside care. Facility care needs to be improved and the CCM program should target those few children still not accessing care.
authors: Knowledge Management and Implementation Research Unit, Health Section, Programme Division, United Nations Children's Fund, NY, New York, USA. tdiaz@unicef.org
authors: Theresa
authors: T
authors: Diaz
authors: Asha S
authors: AS
authors: George
authors: Sowmya R
authors: SR
authors: Rao
authors: Peter S
authors: PS
authors: Bangura
authors: John B
authors: JB
authors: Baimba
authors: Shannon A
authors: SA
authors: McMahon
authors: Augustin
authors: A
authors: Kabano
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics*; D003967:Diarrhea / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008288:Malaria / Q000628:therapy*; D008297:Male; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000628:therapy*; D011204:Poverty Areas; D036301:Qualitative Research; D012424:Rural Population / Q000706:statistics & numerical data; D012807:Sierra Leone