Childhood Illness Prevalence and Determinants of Skilled Care-Seeking Behavior in Rural Eastern Uganda Public

Abstract

Introduction: This study identifies the prevalence of fever, diarrhea, and acute respiratory infection (ARI), and factors associated with skilled health care-seeking behavior among women of children under age three in rural Uganda.

Methods: Using cross-sectional survey data collected in Iganga District, Uganda, the analysis included 3,718 mothers who lived with 4,321 children under three years old. Logistic bivariate and multivariate regressions were used to analyze disease prevalence and factors related to skilled health care-seeking behavior for treatment of child illness.

Results: 57.6% of the children experienced fever in the past two weeks, 26.3% had an illness with cough and 12.4% experienced diarrhea. Children two years of age and older were less likely to experience morbidity than children under one year [ORfever = .82, 95 % CI .66-1.02; ORARI = .52 95% CI .39 - .70; ORdiarrhea = .47 95 % CI .31 - .70]. Of these children, 923 (33.7%) had been taken to an appropriate health facility for care. Factors associated with skilled care-seeking behavior were child age and mother's recognition of signs and symptoms related to child illness. Children aged two and older were more likely to have mothers seek care at a health facility [ORfever = 1.03, 95% CI .72-1.47; ORARI = 1.58, 95 % CI .78-3.20; ORdiarrhea = 1.87, 95% CI .74-4.69] than for children under one year.

Conclusions: The results suggest that child age and mother's recognition of signs and symptoms of child illnesses may be associated with skilled care-seeking behavior. Interventions should be explored that focus on caregivers according to these factors, thereby better addressing barriers and optimizing health outcomes especially for children at risk of dying before the age of five.

Table of Contents

Definition of Terms 1
Chapter 1: Introduction and Background 2
Introduction 2
Purpose Statement 4
Research Questions 4
Background 5
Under-5 Mortality - Globally and in Uganda 5
Uganda's Healthcare System and Health Care Services 7
Overview of Safe Mothers, Safe Babies 10
SAFE's ACT (Action, Care, Transport) for Child Health Project 11
Chapter 2: Literature Review 13
Global, National, and Local Burden of Child Illness 14
Theoretical Frameworks for Conceptualizing Care-Seeking 15
The Three Delays Model 15
Health Behavior Model 17
Mortality Reduction Strategies 18
Factors Associated with Care-Seeking Behavior for Children Under Five 19
Factors Related to Decision-Making 22
Child Variables 23
Chapter 3: Conceptual Framework 26
Summary of Research Gap and Study Rationale 28
Chapter 4: Data and Methods 29
Population and Sample 30
Setting 30
Study Population 31
Sample Size and Sampling Methodology 31
Ethical Considerations 32
Research Design 33
Survey Instrument 33
Survey Procedures 35
Data Analysis 39
Outcome Measure 41
Explanatory Variables 42
Chapter 5: Results 45
Descriptive Statistics 45
Maternal and Child Characteristics 45
Recognition of Child Illness 47
Time to Decide to Seek Skilled Care 49
Prevalence of Early Childhood Illness 50
Prevalence of Early Childhood Illness 50
Prevalence and Determinants of Skilled Care-Seeking for Early Childhood Illness 57
Prevalence of Skilled Care-Seeking for Early Childhood Illness 57
Determinants of Skilled Care-seeking Behavior 59
Chapter 6: Discussion 64
Strengths and Limitations 66
Chapter 7: Conclusion and Recommendations 67
References 69
Appendices 74

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	skilled care seeking child health Uganda
Committee Chair / Thesis Advisor	Argeseanu, Solveig, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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