title: Care seeking behaviour for children with suspected pneumonia in countries in sub-Saharan Africa with high pneumonia mortality.
abstract: Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as 'appropriate' providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16-18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3-39.3) more likely to be brought for care than children from the poorest households, after controlling for the child's age, sex, caregiver's education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic responses.
authors.affiliation: Maastricht University, School for Public Health and Primary Care (CAPHRI), Maastricht, the Netherlands.
authors.forename: Aaltje Camielle
authors.initials: AC
authors.lastname: Noordam
authors.affiliation: Division of Policy and Strategy, Data and Analytics Section, United Nations Children Fund (UNICEF), New York, New York, United States of America.
authors.forename: Liliana
authors.initials: L
authors.lastname: Carvajal-Velez
authors.affiliation: Health Section, United Nations Children Fund (UNICEF), New York, New York, United States of America.
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Sharkey
authors.affiliation: Health Section, United Nations Children Fund (UNICEF), New York, New York, United States of America.
authors.forename: Mark
authors.initials: M
authors.lastname: Young
authors.affiliation: Maastricht University, School for Public Health and Primary Care (CAPHRI), Maastricht, the Netherlands.
authors.forename: Jochen W L
authors.initials: JW
authors.lastname: Cals
mesh_terms: D017954:Africa South of the Sahara; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D015438:Health Behavior; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000523:psychology*; D012424:Rural Population / Q000706:statistics & numerical data