title: Care-Seeking for Diarrhoea in Southern Malawi: Attitudes, Practices and Implications for Diarrhoea Control.
abstract: This paper examined care-seeking behaviour and its associated risk factors when a family member had diarrhoea. Data was obtained from a survey conducted in Chikwawa, a district in Southern Malawi. Chikwawa is faced with a number of environmental and socioeconomic problems and currently diarrhoea morbidity in the district is estimated at 24.4%, statistically higher than the national average of 17%. Using hierarchically built data from a survey of 1403 households nested within 33 communities, a series of two level binary logistic regression models with Bayesian estimation were used to determine predictors of care-seeking behaviour. The results show that 68% of mothers used oral rehydration solutions (ORS) the last time a child in their family had diarrhoea. However, when asked on the action they take when a member of their household has diarrhoea two thirds of the mothers said they visit a health facility. Most respondents (73%) mentioned distance and transport costs as the main obstacles to accessing their nearest health facility and the same proportion of respondents mentioned prolonged waiting time and absence of health workers as the main obstacles encountered at the health facilities. The main predictor variables when a member of the family had diarrhoea were maternal age, distance to the nearest health facility, school level, and relative wealth, household diarrhoea endemicity, and household size while the main predictor variables when a child had diarrhoea were existence of a village health committee (VHC), distance to the nearest health facility, and maternal age. Most households use ORS for the treatment of diarrhoea and village health committees and health surveillance assistants (HSAs) are important factors in this choice of treatment. Health education messages on the use and efficacy of ORS to ensure proper and prescribed handling are important. There is need for a comprehensive concept addressing several dimensions of management and proper coordination of delivery of resources and services; availability of adequate healthcare workers at all levels; affordability to accessibility of healthcare resources and services to all communities; acceptability and quality of care; intensification of health education messages on the use and management of ORS, and prompt and timely treatment of diarrhoeal illness.
authors.affiliation: Centre for Water, Sanitation, Health and Appropriate Technology Development, University of Malawi, The Polytechnic, P/B 303, Chichiri, Blantyre 3, Malawi. salule.masangwi@strath.ac.uk.|Department of Mathematics and Statistics, University of Malawi, The Polytechnic, P/B 303, Chichiri, Blantyre 3, Malawi. salule.masangwi@strath.ac.uk.
authors.forename: Salule
authors.initials: S
authors.lastname: Masangwi
authors.affiliation: Environmental Health, Department of Civil Engineering, University of Strathclyde, Glasgow G4 0NG, UK. n.s.ferguson@strath.ac.uk.
authors.forename: Neil
authors.initials: N
authors.lastname: Ferguson
authors.affiliation: Centre for Water, Sanitation, Health and Appropriate Technology Development, University of Malawi, The Polytechnic, P/B 303, Chichiri, Blantyre 3, Malawi. tonygrimason@yahoo.com.|Environmental Health, Department of Civil Engineering, University of Strathclyde, Glasgow G4 0NG, UK. tonygrimason@yahoo.com.
authors.forename: Anthony
authors.initials: A
authors.lastname: Grimason
authors.affiliation: Centre for Water, Sanitation, Health and Appropriate Technology Development, University of Malawi, The Polytechnic, P/B 303, Chichiri, Blantyre 3, Malawi. tracythomson@africa-online.net.|Environmental Health, Department of Civil Engineering, University of Strathclyde, Glasgow G4 0NG, UK. tracythomson@africa-online.net.|Scotland Chikwawa Health Initiative (SCHI), P.O. Box 30376, Blantyre 3, Malawi. tracythomson@africa-online.net.
authors.forename: Tracy
authors.initials: T
authors.lastname: Morse
authors.affiliation: Department of Statistics and Population Studies, Faculty of Science, University of Namibia, P/B 13301, Windhoek, Namibia. lkazembe@yahoo.com.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kazembe
mesh_terms: D000293:Adolescent; D000328:Adult; D001499:Bayes Theorem; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003967:Diarrhea / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006268:Health Facilities / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D055815:Young Adult
keywords: Southern Malawi; care-seeking behaviour; diarrhoea; multilevel modelling