title: Factors influencing the low utilization of curative child health services in Shebedino District, Sidama Zone, Ethiopia.
abstract: BACKGROUND
  Use and coverage of curative interventions for childhood pneumonia, diarrhea, and malaria were low in Ethiopia before integrated community-based case management (iCCM).
  
  
  OBJECTIVE
  To examine factors accounting for low use of iCCMin Shebedino District applying a "Pathway to Sur- vival" approach to assess illness recognition; home care; labeling and decision-making; patterns of care-seeking; access, availability and quality of care; and referral.
  
  
  METHODS
  Shortly after introduction of iCCM, we conducted five studies in Shebedino District in May 2011: a population-based household survey; focus group discussions of mothers of recently ill children; key informant in- terviews, including knowledge assessment, with Health Extension Workers at health posts and with health workers at health centers; and an inventory of drugs, supplies, and job aids at health posts and health centers.
  
  
  RESULTS
  The many barriers to use of evidence-based treatment included: (1) home remedies of uncertain effect and safety that delay care-seeking; (2) absent decision-maker; (3) fear of stigma; (4) expectation of non-availability of service or medicine; (5) geographic and financial barriers; (6) perception of (or actual) poor quality of care; and (7) accessible, available, affordable, reliable, non-standard, alternative sources of care.
  
  
  CONCLUSIONS
  Only a system-strengthening approach can overcome such manifold barriers to use of curative care that has not increased much after ICCM introduction.
authors.forename: Worku
authors.initials: W
authors.lastname: Tefera
authors.forename: Hailu
authors.initials: H
authors.lastname: Tesfaye
authors.forename: Abeba
authors.initials: A
authors.lastname: Bekele
authors.forename: Elias
authors.initials: E
authors.lastname: Kayessa
authors.forename: Karen Z
authors.initials: KZ
authors.lastname: Waltensperger
authors.forename: David R
authors.initials: DR
authors.lastname: Marsh
mesh_terms: D019090:Case Management / Q000706:statistics & numerical data*; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003153:Community Health Services / Q000706:statistics & numerical data*; D003657:Decision Making; D003967:Diarrhea / Q000628:therapy; D005002:Ethiopia; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008288:Malaria / Q000628:therapy; D010342:Patient Acceptance of Health Care; D011014:Pneumonia / Q000628:therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data