Association between caregivers' knowledge and care seeking behaviour for children with symptoms of pneumonia in six sub-Saharan African Countries.
Pneumonia is the main cause of child mortality world-wide and most of these deaths occur in sub-Saharan Africa (SSA). Treatment with effective antibiotics is crucial to prevent these deaths; nevertheless only 2 out of 5 children with symptoms of pneumonia are taken to an appropriate care provider in SSA. While various factors associated with care seeking have been identified, the relationship between caregivers' knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia is not well researched.



Based on data from Multiple Indicator Cluster Surveys, we assessed the association between caregivers' knowledge of symptoms related to pneumonia - namely fast or difficulty breathing - and care seeking behaviour for these symptoms. We analysed data of 4,163 children with symptoms of pneumonia and their caregivers. A Chi-square tests and multivariable logistic regression was performed to assess the association between care seeking and knowledge of at least one symptom (i.e., fast or difficulty breathing).



Across all 6 countries only around 30% of caregivers were aware of at least one of the two symptoms of pneumonia (i.e., fast or difficulty breathing). Our study shows that in the Democratic Republic of the Congo and Nigeria there was a positive association between knowledge and care seeking (P ≤ 0.01), even after adjusting for key variables (including wealth, residence, education). We found no association between caregivers' knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia in Central African Republic, Chad, Malawi, and Sierra Leone.



These findings reveal an urgent need to increase community awareness of pneumonia symptoms, while simultaneously designing context specific strategies to address the fundamental challenges associated with timely care seeking.
CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. box 616, Maastricht, The Netherlands. acnoordam@hotmail.com.
Aaltje Camielle
AC
Noordam
United Nations Children Fund (UNICEF), Three United Nations Plaza, New York, NY, 10017, USA.
Alyssa B
AB
Sharkey
CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. box 616, Maastricht, The Netherlands.
Paddy
P
Hinssen
CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. box 616, Maastricht, The Netherlands.
GeertJan
G
Dinant
CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. box 616, Maastricht, The Netherlands.
Jochen W L
JW
Cals
D017954:Africa South of the Sahara / Q000453:epidemiology; D017028:Caregivers / Q000592:standards*; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000175:diagnosis* / Q000401:mortality; D011795:Surveys and Questionnaires