title: Heterogeneity in health seeking behaviour for treatment, prevention and urgent care in four districts in western Kenya.
abstract: OBJECTIVE
  The impact of effective, life-saving health interventions is limited by access to and use of health services. Health seeking behaviour is likely to vary geographically and by type of health concern. However, little is known about the extent of this heterogeneity.
  
  
  METHODS
  A representative cluster-randomized sample of households in four districts in western Kenya was interviewed using a structured, interviewer-administered survey. GPS coordinates of all households and all local health facilities were also collected.
  
  
  METHODS
  Household surveys measured health seeking behaviour for three distinct health needs: family planning which is a form of prevention, delivery which is an urgent care need but can be planned in advance, and childhood febrile illness which is an unexpected and potentially life-threatening concern. Logistic regression models were used to explore the relationship between seeking health services and maternal and household characteristics, with special attention to geographic and financial access to care.
  
  
  RESULTS
  Use of health services for these three different health issues varied between the districts and also differed from national estimates. Place of delivery was most strongly correlated with the type of health services available to the family, whereas family planning was correlated with the relationship of the mother to the head of household. There was no strong interaction between socio-economic status and distance to services.
  
  
  CONCLUSIONS
  The level of services available nearest to households rather than the distance to travel influences treatment-seeking behaviour, particularly for urgent care. Maternal factors and household wealth were often important but, even within the same households, their effect changes based on the type of health concern. Generalizing from nationwide surveys may obscure important local heterogeneity, particularly in delivery location and fever treatment.
authors.affiliation: Duke University, School of Medicine, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya. Electronic address: wpo@duke.edu.
authors.forename: W P
authors.initials: WP
authors.lastname: O'Meara
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: S
authors.initials: S
authors.lastname: Karuru
authors.affiliation: Yale University School of Public Health, New Haven, CT, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Fazen
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: J
authors.initials: J
authors.lastname: Koech
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: B
authors.initials: B
authors.lastname: Kizito
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: C
authors.initials: C
authors.lastname: Tarus
authors.affiliation: Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: D
authors.initials: D
authors.lastname: Menya
mesh_terms: D000328:Adult; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000628:therapy*; D040362:Geographic Information Systems; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007630:Kenya; D016015:Logistic Models; D009035:Mothers / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D036301:Qualitative Research; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Access; Health seeking; Maternal and child health