title: Use of health care among febrile children from urban poor households in Senegal: does the neighbourhood have an impact?
abstract: Urban malaria is considered a major public health problem in Africa. The malaria vector is well adapted in urban settings and autochthonous malaria has increased. Antimalarial treatments prescribed presumptively or after rapid diagnostic tests are also highly used in urban settings. Furthermore, health care strategies for urban malaria must comply with heterogeneous neighbourhood ecosystems where health-related risks and opportunities are spatially varied. This article aims to assess the capacity of the urban living environment to mitigate or increase individual or household vulnerabilities that influence the use of health services. The data are drawn from a survey on urban malaria conducted between 2008 and 2009. The study sample was selected using a two-stage randomized sampling. The questionnaire survey covered 2952 households that reported a case of fever episode in children below 10 years during the month before the survey.Self-medication is a widespread practice for children, particularly among the poorest households in Dakar. For rich households, self-medication for children is more a transitional practice enabling families to avoid opportunity costs related to visits to health facilities. For the poorest, it is a forced choice and often the only treatment option. However, the poor that live in well-equipped neighbourhoods inhabited by wealthy residents tend to behave as their rich neighbours. They grasp the opportunities provided by the area and adjust their behaviours accordingly. Though health care for children is strongly influenced by household socio-economic characteristics, neighbourhood resources (facilities and social networks) will promote health care among the poorest and reduce access inequalities. Without being a key factor, the neighbourhood of residence-when it provides resources-may be of some help to overcome the financial hurdle. Findings suggest that the neighbourhood (local setting) is a relevant scale for health programmes in African cities.
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR CHUM) et Université de Daloa (Cote d'ivoire), 850 rue saint Denis Montréal, Canada, karnageorges@gmail.com karnageorges@yahoo.fr.
authors.forename: Georges Karna
authors.initials: GK
authors.lastname: Kone
authors.affiliation: UMR 151 IRD/AMU, Laboratoire Population-Environnement-Développement, Aix-Marseille Université, centre Saint-Charles, Case 10, 3, place Victor-Hugo, 13331 Marseille cedex 3, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Lalou
authors.affiliation: CERDI, CNRS, 65 Boulevard François Mitterrand, 63000 Clermont-Ferrand, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Audibert
authors.affiliation: University of Paris Dauphine 32, avenue Henri Varagnat 93143 Bondy cedex, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Lafarge
authors.affiliation: UMR 151 IRD/AMU, Laboratoire Population-Environnement-Développement, Aix-Marseille Université, centre Saint-Charles, Case 10, 3, place Victor-Hugo, 13331 Marseille cedex 3, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Dos Santos
authors.affiliation: UMR 151 IRD/AMU, Laboratoire Population-Environnement-Développement, Aix-Marseille Université, centre Saint-Charles, Case 10, 3, place Victor-Hugo, 13331 Marseille cedex 3, France.
authors.forename: Alphousseyni
authors.initials: A
authors.lastname: Ndonky
authors.affiliation: University of Paris Dauphine 32, avenue Henri Varagnat 93143 Bondy cedex, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Hesran
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005191:Family Characteristics; D005334:Fever / Q000209:etiology*; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008288:Malaria / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011203:Poverty; D012675:Senegal; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014504:Urban Health; D014505:Urban Population
chemical_list: D000962:Antimalarials
keywords: Access to health care; Dakar; equity; malaria; multilevel analysis; neighbourhood; poverty; social network