title: A qualitative exploration of care-seeking pathways for sick children in the rural Oromia region of Ethiopia.
abstract: Ethiopia has experienced rapid improvements in its healthcare infrastructure, such as through the recent scale up of integrated community case management (iCCM) delivered by community-based health extension workers (HEWs) targeting children under the age of five. Despite notable improvements in child outcomes, the use of HEWs delivering iCCM remains very low. The aim of our study was to explain this phenomenon by examining care-seeking practices and treatment for sick children in two rural districts in the Oromia Region of Ethiopia.
  
  
  
  Using qualitative methods, we explored perceptions of child illness, influences on decision-making processes occurring over the course of a child's illness and caregiver perceptions of available community-based sources of child illness care. Sixteen focus group discussions (FGDs) and 40 in-depth interviews (IDIs) were held with mothers of children under age five. For additional perspective, 16 IDIs were conducted fathers and 22 IDIs with health extension workers and community health volunteers.
  
  
  
  Caregivers often described the act of care-seeking for a sick child as a time of considerable uncertainty. In particular, mothers of sick children described the cultural, social and community-based resources available to minimize this uncertainty as well as constraints and strategies for accessing these resources in order to receive treatment for a sick child. The level of trust and familiarity were the most common dynamics noted as influencing care-seeking strategies; trust in biomedical and government providers was often low.
  
  
  
  Overall, our research highlights the multiple and dynamic influences on care-seeking for sick children in rural Ethiopia. An understanding of these influences is critical for the success of existing and future health interventions and continued improvement of child health in Ethiopia.
authors.affiliation: Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Shaw
authors.affiliation: Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Agbessi
authors.initials: A
authors.lastname: Amouzou
authors.affiliation: Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Miller
authors.affiliation: Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bryce
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. psurkan@jhu.edu.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
mesh_terms: D017028:Caregivers / Q000706:statistics & numerical data; D019090:Case Management; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D003153:Community Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D003150:Community Health Workers / Q000458:organization & administration / Q000706:statistics & numerical data; D003657:Decision Making; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005002:Ethiopia; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012423:Rural Health; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D035502:Trust; D035501:Uncertainty
keywords: Careseeking; Child health; Ethiopia; Health care utilization; Qualitative research; Rural communities