Level of modern health care seeking behaviors among mothers having under five children in Dangila town, north West Ethiopia, 2016: a cross sectional study

Level of modern health care seeking behaviors among mothers having under five children in Dangila... Background: Health seeking behavior is an action taken by an individual who perceive to have a health problem. In most developing countries including Ethiopia the health of the children is strongly dependant on maternal health care behavior. Most childhood morbidities and mortalities are associated with low level of mothers health care seeking behavior. Therefore, the objective of this study was to assess level of modern health care seeking behavior among mothers having under five children in Dangila town, North West Ethiopia. Methods: Community based quantitative cross-sectional study was conducted from April 15 to May 15, 2016. Systematic random sampling technique was used to select study participants. A total of273 mothers with children less than five years were included in this study. The data was collected from all five Kebeles using interviewer administered questionnaire. Descriptive and inferential statistics were used to present the data. Both bivariate and multivariate logistic regression analyses were used to identify factors associated with level of modern health care seeking behavior. Results: Prevalence of modern health care seeking behavior was 82.1%. Age of mothers (AOR = 2.4(1.1, 5.3), age of the child (AOR = 6.7(2.8, 22.2), severity of illness (AOR = 5.2(1.2, 22.6) and family number (AOR = 6.4(2.1, 20.2) were predictors of modern health care seeking behavior among mothers. Conclusions: Majority of the mothers preferred to take their children to modern health care when they got illness. Age of children, age of mother, number of family and severity of illness were the determinant factors for modern health care seeking behavior. Therefore, health care services should be strengthened at community level through community integrated management of childhood illness, information, education communication / behavioral change communication strategies to improve mothers health care seeking behaviors. Keywords: Modern health care seeking behavior, Under five children, Dangila, North West Ethiopia Background Although modern health care interventions have the po- Globally, 6.3 million children under the age of five years tential to substantially reduce childhood mortalities, a died each year. Sub-Saharan countries are among the re- large number of children in developing countries died gions where under five mortalities are highest [1]. without ever reaching in health care facilities. Inability to The Ethiopian demographic health survey (EDHS recognize potentially life threatening conditions and plur- 2011) showed under five mortality rates were higher alistic care seeking practices were the factors that make among children from poor and non educated families. mothers to delay in seeking modern care timely. This The risk of child death was higher in childrens who have delay affected child health significantly and leads to com- uneducated mother [2]. plications that make the medical care less effective [3]. Treatments of common childhood illness like diarrhea, malaria and pneumonia are usually very effective if the * Correspondence: bezatewabe01@gmail.com College of Medicine and Health science, Bahir Dar University, Bahir Dar, Ethiopia care is sought on time. However, to implement ongoing Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Dagnew et al. Italian Journal of Pediatrics (2018) 44:61 Page 2 of 6 programs and to facilitate appropriate care remained as Ethics approval and consent to participate a challenge now a days [4]. Ethical clearance was obtained from AAU, department Therefore, the morbidity and mortalities from these of nursing and midwifery research committee. Each diseases can be reduced when care is sought early. The study participant was adequately informed about the ob- ability of caregivers to recognize and seek appropriate jective of the study, anticipated benefits and risk of the care of childhood illnesses is instrumental in reducing study by their respective data collector. Verbal consent childhood deaths. Appropriate medical care seeking can was obtained from study participants for protecting au- prevent a significant number of childhood deaths and tonomy and ensuring confidentiality . complications [5, 6]. Therefore, the purpose of this study was to assess Results mother’s modern health care seeking behavior for child- Socio demographic characteristics hood illness in Dangila town, North West Ethiopia. In this study, 273 mothers were participated. Above one third 102 (37.4%) of mothers were within the age group Methods of 25 to 29 years with mean age of 28 years. About 66 Community based quantitative cross sectional study was (24.2%) mothers were unable to read and write, 220 conducted from April 15 to May 15, 2016. The study (80.6%) were married and 134 (49.1%) were house wife’s. was conducted in Dangila town, Awi zone, Amhara Re- Regarding the average household income, about99 gional State, Ethiopia. It is located 485 km Northwest (36.3%) earn greater than 2000 Ethiopian birr per from Addis Ababa and 78 km from Bahir Dar, the cap- month. Most249 (91.2%) mothers had less than or equal ital city of Amhara region. The town has a total of five to five family members. About 229 (83.9%) mothers had kebeles. It has a total of 5, 256 households and 30, 147 one under five children in the house. With regard to peoples and 1937 were under five children. There is a youngest child, 146 (53.6) were females and 190 (69.6%) health center and two private clinics in the town. were above one year (Table 1). The sample size was calculated using single population proportion formula by considering the following as- Health seeking behavior sumptions: prevalence (P) 73%, which is the prevalence The overall four weeks prevalence of common childhood of health seeking behavior in Bahir Dar town, North illness complained by mothers were: cough 70(26%), fever West Ethiopia [7], confidence level (CL) 95%, margin of 65(24%) and diarrhea 55 (20%). Among 224 mothers, 177 error (d) 5% and after considering 10% non response (90%) of mothers made decision for seeking medical care rate the final sample size became 273. Using systematic by their own when their child got illness. While for random sampling technique, by selecting one from every 17(7.6%) cases the decision was made by their husband. seven households, a total of 273 households with under The overall prevalence of modern health care seeking be- five children were selected. The first house hold were havior of mothers was 82.1%. The main reasons men- determined using lottery method which was three.. tioned for not seeking modern health care were: A structured interviewer administered questionnaire perceiving as illness is mild (24.5%), thought as sickness is was used to collect data from mothers with under five incurable (16.3%), shortage of money (16.3%) and long children. It was constructed by adopting from previous period of waiting for medical services (14.3%) (Table 2). research done on similar topics and modified accord- Regarding to perception of illness, nearly half 129 ingly. Four diploma nurses were recruited as data collec- (47.3%) of mothers perceived their child illness was tors and two Bachelor of Science nurses were recruited moderate, and about 156 (57.1%) mothers identifies the as supervisors. All data collectors and supervisors were severity of illness by viewing different symptoms. From oriented and trained on how to interview and record the all, only 8(2.9%) mothers took their child to traditional data one day before the survey. healers for treatment and three of them used traditional The collected data was checked manually for complete- treatment since they believed that disease doesn’t cure ness and consistencies. Then it was coded, entered in EPI by modern health care (Table 3). Info version 3.5.3 and exported to SPSS version 20 for analysis. Descriptive statistics was used to summarize the Factors affecting mothers modern health care seeking sociodemographic characteristics’ of the study participants behavior and level of modern health care seeking behavior. To In the bivariate logistic regression analysis: age of mother, identify factors associated with mothers modern health occupational status, marital status, age of child, number of care seeking behavior binary logistic regression analysis family and disease characteristics were statistically associ- was carried out. Strength of association was measured ated with modern health care seeking behavior. using odds ratio and 95% confidence interval. Statistical In final multivariate analysis: age of the mother, age of significance was declared at P value < 0.05. the child, number of family numbers and perceived severity Dagnew et al. Italian Journal of Pediatrics (2018) 44:61 Page 3 of 6 Table 1 Socio demographic characteristics of mothers/caregivers Table 2 Proportion of common childhood illness among and under five children are in Dangila town, Northwest Ethiopia, mothers/caregivers with under five children’s in Dangila town, 2015 Northwest Ethiopia, 2015 Variable Response Frequency Percent (%) Variable Frequency Percent (N = 273) (N = 273) (%) Age of mothers/ < 25 years 55 20.1 Complains of mothers Cough 70 26 caregivers /care givers. 25–29 years 102 37.4 Difficulty of breathing 31 11 30–34 years 65 23.8 Fever 65 24 ≥35 years 51 18.7 Diarrhea 55 20 Age of child ≤1 years 83 30.4 Ear infection 8 3 >1–5 years 190 69.6 Two and above 44 16 symptoms Sex of children Male 127 46.5 Decision makers for Mothers 177 79.0 Female 146 53.5 medical treatment Fathers 17 7.6 Marital status of Married 220 80.6 mothers. Grand parents 5 2.2 Divorced 43 15.8 Both mothers and 25 11.2 Widowed 10 3.7 fathers. Religion of Mothers/ Orthodox 220 80.6 Distribution of health Treat with Hole water 3 1.1 care givers. seeking behavior Muslim 53 19.4 Self treatment at home 3 1.1 among mothers/ Ethnicity of mothers/ Amhara 173 63.4 care givers Take to traditional 8 2.9 caregivers treatment Others 100 36.6 Did nothing 12 4.4 Educational status Unable to Write 66 24.2 and read. Treat the child by buying 23 8.4 from pharmacy or drug Read and write 37 13.6 sellers Primary school 40 14.7 Take to private health 45 16.5 Secondary school 58 21.2 facility College and above 72 26.4 Take to Government 179 65.9 facility Occupation of mothers/ House wife 134 49.1 care givers. Perceived illness On the same day of 62 22.8 Government work 48 17.6 stayed for medical child hood illness Merchants 62 22.7 care among mothers After one days of 126 46.4 /care takers Labor worker 29 10.6 child hood illness Monthly income. ≤500 3 1.1 After two days of 48 17.4 child hood illness 501–1000 54 19.8 After three days of 37 13.4 1001–1500 56 20.5 child hood illness 1501–2000 61 22.3 Main reasons of No treatment for 62 > 2000 99 36.3 mothers/caregivers sickness for not seeking Family members ≤5 249 91.2 Cost of medical care 11 4.1 medical care > 5 24 8.8 No trust on health 17 6.1 providers competency Number of under 1 229 83.9 five children Lack of time 17 6.1 > 2 44 16.1 a Thought it get better 28 10.2 Tigray, Awe, Oromo by it self Don’t get immediate 39 14.3 of illness were significantly associated with mothers modern care / wait for several health care seeking behavior. times for service Maternal age greater than or equal to 28 years were al- Shortage of money 44 16.3 most 2.4 times more likely to seek modern health care Thought sickness is 44 16.3 than those mothers less than 28 years [AOR = 2.4(1.1, incurable 5.4)]. Mothers who had children less than one years of Illness was mild 67 24.5 age were 6.7 times higher to seek modern health care than a mothers who have a child greater than one year’s Dagnew et al. Italian Journal of Pediatrics (2018) 44:61 Page 4 of 6 Table 3 Perception of mothers/caregivers about severity of health care than mothers who perceive the illness was common childhood illness among mothers/caregivers having mild [AOR = 5.2(1.2, 22.6)] (Table 4). under five children’s in Dangila town, Northwest Ethiopia, 2015 variable Response Frequency Percent (%) Discussion (N = 273) In this study 82.1% mothers were seek modern health Perception of Severe 125 45.8 care when their child got illness. This finding is similar mothers about Moderate 129 47.3 to a study done in North West Ethiopia 84.4% mothers severity of illness. were seek modern care [7], higher than a study done in Mild 19 7 Yemen 51.4% [3]. However it is lower with a study done Ways of identification By combined 156 57.1 for the severity of symptoms in Oromiya region Ethiopia 87% [8] and urban slum 90% disease. of the disease. [9]. This difference may be due to differences in socio My child refused 59 21.6 demographic characteristics like: educational status, cul- to eat ture, economical status. The illness continue 58 21.2 The least frequent action in this study was self treat- for long time ment at home and treatment with holy water which ac- Mothers seeking to No 265 97.1 counts 1.1%. This finding was similar to study carried traditional healers Yes 8 2.9 out in North west Ethiopia only 0.4% of them treat chil- dren illness at home [7] and lower than a study done in Main reasons for Don’t get cure from 3 37.5 selecting traditional medical care Nigeria 34.3% of them were treated at home [10]. This healers Treatment is effective 3 37.5 difference may be due to the presence of health package policy in Ethiopia like: expanding health extension pro- Because family 225 recommend to it grams, coordinated maternal and child health service and health education packages have been given at large. In this study 79% of mothers were decision makers for [AOR = 6.7(2.9, 22.2)] . Mothers who have less than or seeking medical care by their own and the mean length equal to five family members were almost 6.4 times of stay for treatment was two days. This result is similar more likely to seek modern health care than mothers to study done in Oromiya region Ethiopia [8] mean who have greater than five family members [AOR = length of stay for medical treatment is two days, slightly 6.4(2.1, 20.2)] and mothers who perceive as their child faster than study results in Yemen most of mothers seek illness was severe were five times higher to seek modern medical care after three days of onset of illness [3]. This Table 4 Factors that affect Health seeking behavior of mothers/care givers among children’s having common childhood illness using bivariate and multivariate logistic regression analysis model, in Dangila town, Northwest Ethiopia, 2015 Variables Response Yes No COR (95% CI) AOR (95% CI) Mother’s age < 28 94(34.4) 30(11) 1 ≥28 130(47.6) 19(7) 2.2(1.2–4.1) 2.4(1.1, 5.4)* Age of children’s ≤1 years 79 (28.9) 4(1.5) 6.1(2.1–17.7) 6.9(2.9, 22.2)* >1–5 years 145(53.1) 45(16.9) 1 Marital status of mothers Married 189(69.2) 31(11.4) 4.1(1.1, 15.2)* Divorced 29(110.6 14(5.1) 1.4(0.3, 5.7) Widowed 4(1.5) 6(2.2) 1 Number of family members ≤5 210(76.9) 39(14.3) 3.8(1.6, 9.3) 6.4(2.1, 20.2)* > 5 14(5.1) 10(3.7) 1 Occupation of mothers/caregivers House wife 110(40.3) 24(8.8) 2.1(0.8–5.1) Government work 44(16.1) 4(1.5) 4.9(1.4–18.0) Merchant 50(18.3) 12(4.4) 1.9(0.1–5.1) Labor worker 20(7.3) 9(3.3) 1 Severity of illness Sever 118(43.2) 7(2.6) 6.0(1.7–21.5) 5.2(1.2, 22.6)* Moderate 92(33.7) 37(13.6) 0.888(0 .3–2.6) Mild 14(5.1) 5(1.8) 1 *Statistically significant (p ≤ 0.05) on multi-variant logistic regression analysis Dagnew et al. Italian Journal of Pediatrics (2018) 44:61 Page 5 of 6 could be due to differences in sociodemographic charac- behavior. Recommendation to improve health seeking teristics and health care seeking behavior. This is also re- behavior include: informing the district health office to lated to expansion of urban health extension programs encourage family planning, educate, support and counsel that creates awareness on early health seeking behavior. the community at large and particularly to the women Age of mother is one predictor of modern health care regarding the importance of seeking medical care. seeking behavior. Studies done in Nigeria and Ethiopia Health education about childhood illness in religious [7, 11] had reported a positive relationship between ma- places, in schools and in meetings to increase awareness ternal age and health care seeking behavior, which is in of mothers modern health care seeking behavior. agreement with the present study. This may be due to as the age of mother increases they will get experiences Limitations that help them to easily identify illness and seek medical A limitation of this study was that it assessed only the care. quantitative aspects of level of modern health care seek- Mothers who had infants were seven times higher to ing behavior among mothers having under five children. seek modern care than those mothers who have older Qualitative study was not incorporated. children. This finding is comparable to study done in Abbreviations Kenya, health care seeking was highest in the youngest AOR: Adjusted Odds Ratio; COR: Crude Odds Ratio; EDHS: Ethiopian age group (62.9%) and slowly declined thereafter for Demographic Health Survey; FMOH: Federal Ministry of Health; HSB: Health older groups 42.5% [12] and in a study conducted in Seeking Behavior; UMR: Under five Mortality Rate; UNICEF: United Nation International Children’s Emergency Fund; WHO: World Health Organization North West Ethiopia [7]. This may be due to young in- fants were highly vulnerable to common childhood ill- Acknowledgements ness than elder ones and makes mothers to seek modern Authors express duly acknowledged the study participants are for voluntarily responding to the questionnaire and for data collectors and supervisors for care easily. their cooperation during the field work. Those mothers who have less than or equal to five family members were around six times higher to seek Funding medical care than to those who have greater than five The authors received financial support to conduct this study from Addis Ababa University, College of Medicine and Health Science, Addis Ababa, family members. This result is in line with a study in Ethiopia. India those residing in joint family structures are pre- dicting health seeking behaviors [13]. This may be re- Availability of data and materials All the data is presented in the main manuscript but can’t be shared lated to low economy of the family and shortage of publically due to presence of sensitive (confidential) participants’ information. money for medical treatments. In the current study, mothers who perceived illness was Authors’ contributions severe were five times more likely to seek medical care AB, TT and RM conceived and designed study, collected, analyzed and interpreted data; drafted the manuscript for important intellectual content. than those who perceive the illness is mild. This finding is The authors reviewed and revised the draft further and approved the final similar to a systemic review done in developing countries, version for submission. study carried out in Yemen and Kenya [3, 12, 14]. This dif- Ethics approval and consent to participate ference may be due to mothers belief of illness will im- Ethical clearance obtained from Addis Ababa University, department of prove by itself and wait until their child show other nursing and midwifery research committee. All participants provided verbal symptom. consent to participate in the study. In this study, the main reasons for not seeking modern Competing interests care were: percived illness was mild 12 (24.5%), thought The authors declared that they have no competing interests. sickness is incurable by medicine 8(16.3%) and shortage of money (2%) and this is an agreement with studies in Publisher’sNote Yemen illness was mild (39%), illness do not need med- Springer Nature remains neutral with regard to jurisdictional claims in ical treatment (31%) but contrasts to studies conducted published maps and institutional affiliations. in Amhara region: the disease did not need treat- Author details ment(31.9%), bought drugs from drug vendors (27.2%), College of Medicine and Health science, Bahir Dar University, Bahir Dar, Ethiopia. perception of the disease resolves by itself (56.7%), lack College of Health Sciences School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. of money 24% [7, 15]. Received: 9 March 2018 Accepted: 23 May 2018 Conclusion The overall health seeking behaviors of mothers who References have under five children was 82.1%.Age of the mother, 1. WHO. Children: reducing mortality. Geneva (Fact Sheet No 178). 2013. age of the child, family number and perceived severity of 2. Ministry of Finance and Economic Development, Federal Democratic illness were the significant factors for health seeking Republic of Ethiopia. Ethiopia MDGs report 2012. Dagnew et al. Italian Journal of Pediatrics (2018) 44:61 Page 6 of 6 3. Webair HH, Bin-Gouth SA. Factors affecting health seeking behavior for common childhood illnesses in Yemen. Patient Preference and Adherence. 2013;7:1129. 4. Health Seeking Behaviour. [cited 18 Jan, 2015]; available from: http://ni. unimelb.edu.au/__data/assets/pdf_file/0011/385967/HPHF. 5. Geldsetzer P, Williams TC, Kirolos A, Mitchell S, Ratcliffe LA, Kohli-Lynch MK, et al. The recognition of and care seeking behaviour for childhood illness in developing countries: a systematic review. PLoS One. 2014;9(4):e93427. 6. United Nations (n.d.) Millennium Development Goals website. l2013[cited 21 Jan, 2015]; Availablefrom: http://www.un.org/millenniumgoals/childhealth.shtm. 7. Gelaw YA, Biks GA, Alene KA. Effect of residence on mothers ’ health care seeking behavior for common childhood illness. BMC Research Notes. 2014; 7:705. 8. Assefa T, Belachew T, Tegegn A, Deribew. Mothers’ health care seeking behavior for childhood illnesses. Ethiop J Health Sci. 2008;18(3) 9. Mahejabin F, Parveen S, Ibrahim M. Mother’s / care Giver’s health seeking behaviour during childhood illness. Original article. 2014;7:5-15. 10. Adegboyega AAOA, Salawu O. Care-seeking behaviour of caregivers for common childhood illnesses in Lagos Island local government area. Nigeria Unbound MEDLINE. 2014;14:65–71. 11. Ajibade BL, Amoo PO, Adeleke MA, Oyadiran GO, Kolade OA, Olagunju RO. Determinants of Mothers Health Seeking Behaviour for Their Children. Journal of Nursing and Health Science. 2013;1(6):9–16. 12. Mbagaya GM, Odhiambo MO, Oniang’o RK. Mother’s health seeking behaviour during child illness. Afr Health Sci. 2005;5(4):322–7. 13. Ghosh N, Chakrabarti I, Chakraborty M, Biswas R. Factors affecting the healthcare- seeking behavior of mothers regarding their children. International Journal of Medicine and Public Health. 2013;3(1) 14. Geldsetzer P, Williams TC, Kirolos A, Mitchell S, Ratcliffe LA, Kohli-Lynch MK, et al. Recognition of and care seeking behaviour for childhood illness in developing countries. PLoS One. 2014;9(4):e93427. 15. Fantahun M, Degu G. Health service utilization in Amhara region of Ethiopia. EthiopJHealth Dev. 2003;17(2):141–7. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Italian Journal of Pediatrics Springer Journals

Level of modern health care seeking behaviors among mothers having under five children in Dangila town, north West Ethiopia, 2016: a cross sectional study

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Abstract

Background: Health seeking behavior is an action taken by an individual who perceive to have a health problem. In most developing countries including Ethiopia the health of the children is strongly dependant on maternal health care behavior. Most childhood morbidities and mortalities are associated with low level of mothers health care seeking behavior. Therefore, the objective of this study was to assess level of modern health care seeking behavior among mothers having under five children in Dangila town, North West Ethiopia. Methods: Community based quantitative cross-sectional study was conducted from April 15 to May 15, 2016. Systematic random sampling technique was used to select study participants. A total of273 mothers with children less than five years were included in this study. The data was collected from all five Kebeles using interviewer administered questionnaire. Descriptive and inferential statistics were used to present the data. Both bivariate and multivariate logistic regression analyses were used to identify factors associated with level of modern health care seeking behavior. Results: Prevalence of modern health care seeking behavior was 82.1%. Age of mothers (AOR = 2.4(1.1, 5.3), age of the child (AOR = 6.7(2.8, 22.2), severity of illness (AOR = 5.2(1.2, 22.6) and family number (AOR = 6.4(2.1, 20.2) were predictors of modern health care seeking behavior among mothers. Conclusions: Majority of the mothers preferred to take their children to modern health care when they got illness. Age of children, age of mother, number of family and severity of illness were the determinant factors for modern health care seeking behavior. Therefore, health care services should be strengthened at community level through community integrated management of childhood illness, information, education communication / behavioral change communication strategies to improve mothers health care seeking behaviors. Keywords: Modern health care seeking behavior, Under five children, Dangila, North West Ethiopia Background Although modern health care interventions have the po- Globally, 6.3 million children under the age of five years tential to substantially reduce childhood mortalities, a died each year. Sub-Saharan countries are among the re- large number of children in developing countries died gions where under five mortalities are highest [1]. without ever reaching in health care facilities. Inability to The Ethiopian demographic health survey (EDHS recognize potentially life threatening conditions and plur- 2011) showed under five mortality rates were higher alistic care seeking practices were the factors that make among children from poor and non educated families. mothers to delay in seeking modern care timely. This The risk of child death was higher in childrens who have delay affected child health significantly and leads to com- uneducated mother [2]. plications that make the medical care less effective [3]. Treatments of common childhood illness like diarrhea, malaria and pneumonia are usually very effective if the * Correspondence: bezatewabe01@gmail.com College of Medicine and Health science, Bahir Dar University, Bahir Dar, Ethiopia care is sought on time. However, to implement ongoing Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Dagnew et al. Italian Journal of Pediatrics (2018) 44:61 Page 2 of 6 programs and to facilitate appropriate care remained as Ethics approval and consent to participate a challenge now a days [4]. Ethical clearance was obtained from AAU, department Therefore, the morbidity and mortalities from these of nursing and midwifery research committee. Each diseases can be reduced when care is sought early. The study participant was adequately informed about the ob- ability of caregivers to recognize and seek appropriate jective of the study, anticipated benefits and risk of the care of childhood illnesses is instrumental in reducing study by their respective data collector. Verbal consent childhood deaths. Appropriate medical care seeking can was obtained from study participants for protecting au- prevent a significant number of childhood deaths and tonomy and ensuring confidentiality . complications [5, 6]. Therefore, the purpose of this study was to assess Results mother’s modern health care seeking behavior for child- Socio demographic characteristics hood illness in Dangila town, North West Ethiopia. In this study, 273 mothers were participated. Above one third 102 (37.4%) of mothers were within the age group Methods of 25 to 29 years with mean age of 28 years. About 66 Community based quantitative cross sectional study was (24.2%) mothers were unable to read and write, 220 conducted from April 15 to May 15, 2016. The study (80.6%) were married and 134 (49.1%) were house wife’s. was conducted in Dangila town, Awi zone, Amhara Re- Regarding the average household income, about99 gional State, Ethiopia. It is located 485 km Northwest (36.3%) earn greater than 2000 Ethiopian birr per from Addis Ababa and 78 km from Bahir Dar, the cap- month. Most249 (91.2%) mothers had less than or equal ital city of Amhara region. The town has a total of five to five family members. About 229 (83.9%) mothers had kebeles. It has a total of 5, 256 households and 30, 147 one under five children in the house. With regard to peoples and 1937 were under five children. There is a youngest child, 146 (53.6) were females and 190 (69.6%) health center and two private clinics in the town. were above one year (Table 1). The sample size was calculated using single population proportion formula by considering the following as- Health seeking behavior sumptions: prevalence (P) 73%, which is the prevalence The overall four weeks prevalence of common childhood of health seeking behavior in Bahir Dar town, North illness complained by mothers were: cough 70(26%), fever West Ethiopia [7], confidence level (CL) 95%, margin of 65(24%) and diarrhea 55 (20%). Among 224 mothers, 177 error (d) 5% and after considering 10% non response (90%) of mothers made decision for seeking medical care rate the final sample size became 273. Using systematic by their own when their child got illness. While for random sampling technique, by selecting one from every 17(7.6%) cases the decision was made by their husband. seven households, a total of 273 households with under The overall prevalence of modern health care seeking be- five children were selected. The first house hold were havior of mothers was 82.1%. The main reasons men- determined using lottery method which was three.. tioned for not seeking modern health care were: A structured interviewer administered questionnaire perceiving as illness is mild (24.5%), thought as sickness is was used to collect data from mothers with under five incurable (16.3%), shortage of money (16.3%) and long children. It was constructed by adopting from previous period of waiting for medical services (14.3%) (Table 2). research done on similar topics and modified accord- Regarding to perception of illness, nearly half 129 ingly. Four diploma nurses were recruited as data collec- (47.3%) of mothers perceived their child illness was tors and two Bachelor of Science nurses were recruited moderate, and about 156 (57.1%) mothers identifies the as supervisors. All data collectors and supervisors were severity of illness by viewing different symptoms. From oriented and trained on how to interview and record the all, only 8(2.9%) mothers took their child to traditional data one day before the survey. healers for treatment and three of them used traditional The collected data was checked manually for complete- treatment since they believed that disease doesn’t cure ness and consistencies. Then it was coded, entered in EPI by modern health care (Table 3). Info version 3.5.3 and exported to SPSS version 20 for analysis. Descriptive statistics was used to summarize the Factors affecting mothers modern health care seeking sociodemographic characteristics’ of the study participants behavior and level of modern health care seeking behavior. To In the bivariate logistic regression analysis: age of mother, identify factors associated with mothers modern health occupational status, marital status, age of child, number of care seeking behavior binary logistic regression analysis family and disease characteristics were statistically associ- was carried out. Strength of association was measured ated with modern health care seeking behavior. using odds ratio and 95% confidence interval. Statistical In final multivariate analysis: age of the mother, age of significance was declared at P value < 0.05. the child, number of family numbers and perceived severity Dagnew et al. Italian Journal of Pediatrics (2018) 44:61 Page 3 of 6 Table 1 Socio demographic characteristics of mothers/caregivers Table 2 Proportion of common childhood illness among and under five children are in Dangila town, Northwest Ethiopia, mothers/caregivers with under five children’s in Dangila town, 2015 Northwest Ethiopia, 2015 Variable Response Frequency Percent (%) Variable Frequency Percent (N = 273) (N = 273) (%) Age of mothers/ < 25 years 55 20.1 Complains of mothers Cough 70 26 caregivers /care givers. 25–29 years 102 37.4 Difficulty of breathing 31 11 30–34 years 65 23.8 Fever 65 24 ≥35 years 51 18.7 Diarrhea 55 20 Age of child ≤1 years 83 30.4 Ear infection 8 3 >1–5 years 190 69.6 Two and above 44 16 symptoms Sex of children Male 127 46.5 Decision makers for Mothers 177 79.0 Female 146 53.5 medical treatment Fathers 17 7.6 Marital status of Married 220 80.6 mothers. Grand parents 5 2.2 Divorced 43 15.8 Both mothers and 25 11.2 Widowed 10 3.7 fathers. Religion of Mothers/ Orthodox 220 80.6 Distribution of health Treat with Hole water 3 1.1 care givers. seeking behavior Muslim 53 19.4 Self treatment at home 3 1.1 among mothers/ Ethnicity of mothers/ Amhara 173 63.4 care givers Take to traditional 8 2.9 caregivers treatment Others 100 36.6 Did nothing 12 4.4 Educational status Unable to Write 66 24.2 and read. Treat the child by buying 23 8.4 from pharmacy or drug Read and write 37 13.6 sellers Primary school 40 14.7 Take to private health 45 16.5 Secondary school 58 21.2 facility College and above 72 26.4 Take to Government 179 65.9 facility Occupation of mothers/ House wife 134 49.1 care givers. Perceived illness On the same day of 62 22.8 Government work 48 17.6 stayed for medical child hood illness Merchants 62 22.7 care among mothers After one days of 126 46.4 /care takers Labor worker 29 10.6 child hood illness Monthly income. ≤500 3 1.1 After two days of 48 17.4 child hood illness 501–1000 54 19.8 After three days of 37 13.4 1001–1500 56 20.5 child hood illness 1501–2000 61 22.3 Main reasons of No treatment for 62 > 2000 99 36.3 mothers/caregivers sickness for not seeking Family members ≤5 249 91.2 Cost of medical care 11 4.1 medical care > 5 24 8.8 No trust on health 17 6.1 providers competency Number of under 1 229 83.9 five children Lack of time 17 6.1 > 2 44 16.1 a Thought it get better 28 10.2 Tigray, Awe, Oromo by it self Don’t get immediate 39 14.3 of illness were significantly associated with mothers modern care / wait for several health care seeking behavior. times for service Maternal age greater than or equal to 28 years were al- Shortage of money 44 16.3 most 2.4 times more likely to seek modern health care Thought sickness is 44 16.3 than those mothers less than 28 years [AOR = 2.4(1.1, incurable 5.4)]. Mothers who had children less than one years of Illness was mild 67 24.5 age were 6.7 times higher to seek modern health care than a mothers who have a child greater than one year’s Dagnew et al. Italian Journal of Pediatrics (2018) 44:61 Page 4 of 6 Table 3 Perception of mothers/caregivers about severity of health care than mothers who perceive the illness was common childhood illness among mothers/caregivers having mild [AOR = 5.2(1.2, 22.6)] (Table 4). under five children’s in Dangila town, Northwest Ethiopia, 2015 variable Response Frequency Percent (%) Discussion (N = 273) In this study 82.1% mothers were seek modern health Perception of Severe 125 45.8 care when their child got illness. This finding is similar mothers about Moderate 129 47.3 to a study done in North West Ethiopia 84.4% mothers severity of illness. were seek modern care [7], higher than a study done in Mild 19 7 Yemen 51.4% [3]. However it is lower with a study done Ways of identification By combined 156 57.1 for the severity of symptoms in Oromiya region Ethiopia 87% [8] and urban slum 90% disease. of the disease. [9]. This difference may be due to differences in socio My child refused 59 21.6 demographic characteristics like: educational status, cul- to eat ture, economical status. The illness continue 58 21.2 The least frequent action in this study was self treat- for long time ment at home and treatment with holy water which ac- Mothers seeking to No 265 97.1 counts 1.1%. This finding was similar to study carried traditional healers Yes 8 2.9 out in North west Ethiopia only 0.4% of them treat chil- dren illness at home [7] and lower than a study done in Main reasons for Don’t get cure from 3 37.5 selecting traditional medical care Nigeria 34.3% of them were treated at home [10]. This healers Treatment is effective 3 37.5 difference may be due to the presence of health package policy in Ethiopia like: expanding health extension pro- Because family 225 recommend to it grams, coordinated maternal and child health service and health education packages have been given at large. In this study 79% of mothers were decision makers for [AOR = 6.7(2.9, 22.2)] . Mothers who have less than or seeking medical care by their own and the mean length equal to five family members were almost 6.4 times of stay for treatment was two days. This result is similar more likely to seek modern health care than mothers to study done in Oromiya region Ethiopia [8] mean who have greater than five family members [AOR = length of stay for medical treatment is two days, slightly 6.4(2.1, 20.2)] and mothers who perceive as their child faster than study results in Yemen most of mothers seek illness was severe were five times higher to seek modern medical care after three days of onset of illness [3]. This Table 4 Factors that affect Health seeking behavior of mothers/care givers among children’s having common childhood illness using bivariate and multivariate logistic regression analysis model, in Dangila town, Northwest Ethiopia, 2015 Variables Response Yes No COR (95% CI) AOR (95% CI) Mother’s age < 28 94(34.4) 30(11) 1 ≥28 130(47.6) 19(7) 2.2(1.2–4.1) 2.4(1.1, 5.4)* Age of children’s ≤1 years 79 (28.9) 4(1.5) 6.1(2.1–17.7) 6.9(2.9, 22.2)* >1–5 years 145(53.1) 45(16.9) 1 Marital status of mothers Married 189(69.2) 31(11.4) 4.1(1.1, 15.2)* Divorced 29(110.6 14(5.1) 1.4(0.3, 5.7) Widowed 4(1.5) 6(2.2) 1 Number of family members ≤5 210(76.9) 39(14.3) 3.8(1.6, 9.3) 6.4(2.1, 20.2)* > 5 14(5.1) 10(3.7) 1 Occupation of mothers/caregivers House wife 110(40.3) 24(8.8) 2.1(0.8–5.1) Government work 44(16.1) 4(1.5) 4.9(1.4–18.0) Merchant 50(18.3) 12(4.4) 1.9(0.1–5.1) Labor worker 20(7.3) 9(3.3) 1 Severity of illness Sever 118(43.2) 7(2.6) 6.0(1.7–21.5) 5.2(1.2, 22.6)* Moderate 92(33.7) 37(13.6) 0.888(0 .3–2.6) Mild 14(5.1) 5(1.8) 1 *Statistically significant (p ≤ 0.05) on multi-variant logistic regression analysis Dagnew et al. Italian Journal of Pediatrics (2018) 44:61 Page 5 of 6 could be due to differences in sociodemographic charac- behavior. Recommendation to improve health seeking teristics and health care seeking behavior. This is also re- behavior include: informing the district health office to lated to expansion of urban health extension programs encourage family planning, educate, support and counsel that creates awareness on early health seeking behavior. the community at large and particularly to the women Age of mother is one predictor of modern health care regarding the importance of seeking medical care. seeking behavior. Studies done in Nigeria and Ethiopia Health education about childhood illness in religious [7, 11] had reported a positive relationship between ma- places, in schools and in meetings to increase awareness ternal age and health care seeking behavior, which is in of mothers modern health care seeking behavior. agreement with the present study. This may be due to as the age of mother increases they will get experiences Limitations that help them to easily identify illness and seek medical A limitation of this study was that it assessed only the care. quantitative aspects of level of modern health care seek- Mothers who had infants were seven times higher to ing behavior among mothers having under five children. seek modern care than those mothers who have older Qualitative study was not incorporated. children. This finding is comparable to study done in Abbreviations Kenya, health care seeking was highest in the youngest AOR: Adjusted Odds Ratio; COR: Crude Odds Ratio; EDHS: Ethiopian age group (62.9%) and slowly declined thereafter for Demographic Health Survey; FMOH: Federal Ministry of Health; HSB: Health older groups 42.5% [12] and in a study conducted in Seeking Behavior; UMR: Under five Mortality Rate; UNICEF: United Nation International Children’s Emergency Fund; WHO: World Health Organization North West Ethiopia [7]. This may be due to young in- fants were highly vulnerable to common childhood ill- Acknowledgements ness than elder ones and makes mothers to seek modern Authors express duly acknowledged the study participants are for voluntarily responding to the questionnaire and for data collectors and supervisors for care easily. their cooperation during the field work. Those mothers who have less than or equal to five family members were around six times higher to seek Funding medical care than to those who have greater than five The authors received financial support to conduct this study from Addis Ababa University, College of Medicine and Health Science, Addis Ababa, family members. This result is in line with a study in Ethiopia. India those residing in joint family structures are pre- dicting health seeking behaviors [13]. This may be re- Availability of data and materials All the data is presented in the main manuscript but can’t be shared lated to low economy of the family and shortage of publically due to presence of sensitive (confidential) participants’ information. money for medical treatments. In the current study, mothers who perceived illness was Authors’ contributions severe were five times more likely to seek medical care AB, TT and RM conceived and designed study, collected, analyzed and interpreted data; drafted the manuscript for important intellectual content. than those who perceive the illness is mild. This finding is The authors reviewed and revised the draft further and approved the final similar to a systemic review done in developing countries, version for submission. study carried out in Yemen and Kenya [3, 12, 14]. This dif- Ethics approval and consent to participate ference may be due to mothers belief of illness will im- Ethical clearance obtained from Addis Ababa University, department of prove by itself and wait until their child show other nursing and midwifery research committee. All participants provided verbal symptom. consent to participate in the study. In this study, the main reasons for not seeking modern Competing interests care were: percived illness was mild 12 (24.5%), thought The authors declared that they have no competing interests. sickness is incurable by medicine 8(16.3%) and shortage of money (2%) and this is an agreement with studies in Publisher’sNote Yemen illness was mild (39%), illness do not need med- Springer Nature remains neutral with regard to jurisdictional claims in ical treatment (31%) but contrasts to studies conducted published maps and institutional affiliations. in Amhara region: the disease did not need treat- Author details ment(31.9%), bought drugs from drug vendors (27.2%), College of Medicine and Health science, Bahir Dar University, Bahir Dar, Ethiopia. perception of the disease resolves by itself (56.7%), lack College of Health Sciences School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. of money 24% [7, 15]. Received: 9 March 2018 Accepted: 23 May 2018 Conclusion The overall health seeking behaviors of mothers who References have under five children was 82.1%.Age of the mother, 1. WHO. Children: reducing mortality. Geneva (Fact Sheet No 178). 2013. age of the child, family number and perceived severity of 2. Ministry of Finance and Economic Development, Federal Democratic illness were the significant factors for health seeking Republic of Ethiopia. Ethiopia MDGs report 2012. Dagnew et al. Italian Journal of Pediatrics (2018) 44:61 Page 6 of 6 3. Webair HH, Bin-Gouth SA. Factors affecting health seeking behavior for common childhood illnesses in Yemen. Patient Preference and Adherence. 2013;7:1129. 4. Health Seeking Behaviour. [cited 18 Jan, 2015]; available from: http://ni. unimelb.edu.au/__data/assets/pdf_file/0011/385967/HPHF. 5. Geldsetzer P, Williams TC, Kirolos A, Mitchell S, Ratcliffe LA, Kohli-Lynch MK, et al. The recognition of and care seeking behaviour for childhood illness in developing countries: a systematic review. PLoS One. 2014;9(4):e93427. 6. United Nations (n.d.) Millennium Development Goals website. l2013[cited 21 Jan, 2015]; Availablefrom: http://www.un.org/millenniumgoals/childhealth.shtm. 7. Gelaw YA, Biks GA, Alene KA. Effect of residence on mothers ’ health care seeking behavior for common childhood illness. BMC Research Notes. 2014; 7:705. 8. Assefa T, Belachew T, Tegegn A, Deribew. Mothers’ health care seeking behavior for childhood illnesses. Ethiop J Health Sci. 2008;18(3) 9. Mahejabin F, Parveen S, Ibrahim M. Mother’s / care Giver’s health seeking behaviour during childhood illness. Original article. 2014;7:5-15. 10. Adegboyega AAOA, Salawu O. Care-seeking behaviour of caregivers for common childhood illnesses in Lagos Island local government area. Nigeria Unbound MEDLINE. 2014;14:65–71. 11. Ajibade BL, Amoo PO, Adeleke MA, Oyadiran GO, Kolade OA, Olagunju RO. Determinants of Mothers Health Seeking Behaviour for Their Children. Journal of Nursing and Health Science. 2013;1(6):9–16. 12. Mbagaya GM, Odhiambo MO, Oniang’o RK. Mother’s health seeking behaviour during child illness. Afr Health Sci. 2005;5(4):322–7. 13. Ghosh N, Chakrabarti I, Chakraborty M, Biswas R. Factors affecting the healthcare- seeking behavior of mothers regarding their children. International Journal of Medicine and Public Health. 2013;3(1) 14. Geldsetzer P, Williams TC, Kirolos A, Mitchell S, Ratcliffe LA, Kohli-Lynch MK, et al. Recognition of and care seeking behaviour for childhood illness in developing countries. PLoS One. 2014;9(4):e93427. 15. Fantahun M, Degu G. Health service utilization in Amhara region of Ethiopia. EthiopJHealth Dev. 2003;17(2):141–7.

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Italian Journal of PediatricsSpringer Journals

Published: May 29, 2018

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