Demographic and socio-economic characteristics of respondents
A total of 661 caregivers’ were interviewed giving an overall response rate of 98%, and the majority 92.6% of them was married. Almost all, 99.1%, of the study participants were mothers as primary caregivers.
The mean (±SD) age of caregivers’ was 37.44 (±7.29) with a range of 21 to 68 years. Most of the respondents (84.6%) were in the age group of 25-45 years and all most all 623 (94%) of participants were Orthodox by religion.
Regarding the occupational status of respondents, the majority 473 (71.6%) were housewives followed by government-employed (19%), and nearly two-thirds of the respondents 419 (63%) had only one under-five child.
With regard to the sex of the child nearly half 333 (50.4%) were males and the rest 49.6% were females. The mean (±SD) age of children was 24.19 (±13.3) months ranging from 2-58 months. Two hundred seventy four (41.5%) of them were within the age group of 25-36 months.
The median monthly income of respondents were 900 birr with the range of 100 to 8000 birr per month and only 306 (46.3%) of respondents have attended formal education.
Table 1: Demographic and socio-economic characteristics of study participants in Efratana Gidim district, east Amhara, Ethiopia, 2020 (n=661).
Variables
|
Category
|
Frequency (n)
|
Percent (%)
|
Sex
|
Female
|
655
|
99.1
|
Male
|
6
|
0.9
|
Age
|
<25
|
22
|
3.3
|
25-45
|
559
|
84.6
|
46-65
|
79
|
12
|
>65
|
1
|
0.2
|
Marital status
|
Married
|
612
|
92.6
|
Widowed
|
24
|
3.6
|
Divorced
|
25
|
3.8
|
Education
|
Illiterate
|
355
|
53.7
|
Elementary
|
105
|
15.9
|
Secondary
|
142
|
21.5
|
Higher
|
59
|
8.9
|
Religion
|
Orthodox
|
623
|
94.3
|
Muslim
|
23
|
3.5
|
Protestant
|
15
|
2.3
|
Occupation
|
Housewife
|
473
|
71.6
|
Merchant
|
46
|
7
|
Government Employed
|
126
|
19.1
|
Others+
|
16
|
2.4
|
Number of under five Children
|
1
|
419
|
63.4
|
2
|
238
|
36
|
3
|
4
|
0.6
|
Monthly Income
|
<500
|
34
|
5.1
|
500-1000
|
383
|
57.9
|
1001-5000
|
223
|
33.7
|
>5000
|
21
|
3.2
|
Child sex
|
Female
|
328
|
49.6
|
Male
|
333
|
50.4
|
Child Age
|
2-12 Months
|
203
|
30.7
|
13-24 months
|
88
|
13.3
|
25-36 Months
|
274
|
41.5
|
37-59 Months
|
96
|
14.5
|
Others+ includes Farmers and Daily laborers
Enabling and need related characteristics of respondents
Of the total 661 participants responded the average (mean) household size was four in numbers and nearly one third 209 (31.6%) of the respondents were urban residents.
Regarding distance from the health facility and access to transport one-fourth of respondents 161(24.4%) were living more than five-kilo meters far from health institutions, meanwhile, the majority of 302 (45.7%) respondents reported that they did not have any access to transportation services.
Out of the total study, participants interviewed only 38 (5.75%) reported that the household had an experience of child death before the time of interview and only two percent of participants had a sick child with severe disease as perceived by the respondents.
Table 2: Enabling and need related factors of respondents in Efratana Gidim district, east Amhara, Ethiopia, 2020 (n=661).
Variables
|
Category
|
Frequency (n)
|
Percent (%)
|
Distance from Health Facility
|
<=5 km
|
500
|
75.6
|
>5 km
|
161
|
24.4
|
Residence
|
Rural
|
452
|
68.4
|
Urban
|
209
|
31.6
|
Family Size
|
<=5
|
546
|
82.6
|
>5
|
115
|
17.4
|
Severity of disease
|
Severe
|
13
|
2
|
None severe
|
648
|
98
|
Experience of Child death
|
Yes
|
38
|
5.75
|
No
|
623
|
94.25
|
Access to Transportation
|
Yes
|
209
|
31.6
|
Sometimes
|
150
|
22.7
|
No
|
302
|
45.7
|
Childhood illness prevalence
The overall prevalence of common childhood illnesses which have one or more symptoms among under-five children between two and fifty-nine months was 24.1%, (95% CI: 21.1%-27.3%). Out of 661 households surveyed, presence of cough, diarrhea and fever were 16.8%, (95% CI: 14%-19.9%), 11%, (95% CI: 8.8%-13.7%) and 16.9%, (95% CI: 14.2%-20%) respectively.
Furthermore, 2.4%, (95% CI: 1.4%-3.9%) of children between the age of 2-59 months had symptoms of cough, fever, and diarrhea simultaneously.
Healthcare Seeking Behavior
Overall 59.1%, (95% CI: 51.1%-66.8%) of respondents sought healthcare for their sick child. Out of 94 caregivers who have sick children and sought modern medical treatment the most 28.7% of respondent’s primary preference were health institutions followed by traditional healers 17%, holy water 16%, religious institutions 13.8%, at home 12.8% and from pharmacy 11.7%. For caregivers who preferred health facilities, health centers were the most chosen source of healthcare services where treatment was chosen by 50% of caregivers and the rest 35.1% sought treatment from health posts, 8.5% from the hospital, and 6.4% from a private clinic. The major reasons for treatment-seeking from health facilities were the child’s condition worsened 51.1% followed by fear of complication 26.6%, people's advice 18.1%, and facility was nearly 4.3%.
Table 3: Caregivers healthcare seeking behavior for common childhood illnesses in Efratana Gidim district, east Amhara, Ethiopia, 2020.( n=159)
Variables
|
Category
|
Frequency(n)
|
Percent (%)
|
Did you sought treatment (n=159)
|
Yes
|
94
|
59.1
|
No
|
65
|
40.9
|
Where did you first sought Treatment? (n=94)
|
Religious Institution
|
13
|
13.8
|
Health institution
|
27
|
28.7
|
Holy water place
|
15
|
16
|
Traditional healer
|
16
|
17
|
At home
|
12
|
12.8
|
From pharmacy
|
11
|
11.7
|
What type health institution?
(n=94)
|
Health post
|
33
|
35.1
|
Health center
|
47
|
50
|
Hospital
|
8
|
8.5
|
Private clinic
|
6
|
6.4
|
Reason for seeking healthcare
(n=94)
|
Child’s condition worsened
|
48
|
51.1
|
Other peoples advice
|
17
|
18.1
|
Fear of complication
|
25
|
26.6
|
Facility is near by
|
4
|
4.3
|
Time of healthcare seeking
(n=94)
|
Hours
|
2
|
2.1
|
Days
|
72
|
76.6
|
Weeks
|
20
|
21.3
|
Ninety four of caregivers who sought treatment were asked for the time of healthcare-seeking after the onset of symptoms, the majority 72 (76.6%) of caregivers brought medical treatment within days of symptom recognition and 20 (21.3%) were sought treatment weeks after the onset of symptoms and very few caregivers 2 (2.1%) were sought treatment immediately within hours of symptom recognition.
As reported by participants the main reason for not seeking healthcare were identified and mentioned as treatment cost being expensive 19 (29.2%) followed by illness was not serious 16 (24.6%), lack of transportation 13 (20%), lack of money 11 (16.9%), and long-distance from health facility 6 (9.2%).
Factors affecting common childhood illnesses
In the bivariate analysis caregivers’ level of education, religion, occupation, monthly income, residence of caregiver, number of under-five children, and child age were associated with common childhood illness.
However religion of caregiver, occupation, monthly income, and number of under-five children were not significantly associated with childhood illness by multivariable logistic regression analysis.
Meanwhile level of education (AOR=2.56:95%CI: 1.09, 5.99) and caregivers’ residence (AOR=0.26: 95%CI: 0.09, 0.73) were determinant factors of common childhood illnesses at p value <0.05.
Table 4: Factors affecting childhood illness in Efratana Gidim district, Ethiopia, 2020 (n=661)
Variables
|
Childhood illness
Yes No
|
COR (95%CI)
|
AOR (95% CI)
|
Educational Status
|
Illiterate
|
93
|
263
|
1.06(0.57, 1.98)
|
0.96(0.34, 2.75)
|
Elementary
|
34
|
71
|
0.78(0.38, 1.57)
|
0.81(0.27, 2.48)
|
Secondary
|
16
|
125
|
2.74(1.27, 5.88)
|
2.56(1.09, 5.99)*
|
Higher
|
16
|
43
|
1
|
1
|
Religion
|
Orthodox
|
145
|
478
|
1.65(0.55, 4.90)
|
3.21(0.92, 11.24)
|
Muslim
|
9
|
14
|
0.78(0.19, 3.04)
|
0.67(0.15, 2.93)
|
Protestant
|
5
|
10
|
1
|
1
|
Occupation
|
Housewife
|
125
|
348
|
0.58(0.22, 1.55)
|
0.82(0.26, 2.58)
|
Merchant
|
7
|
26
|
0.77(0.22, 2.77)
|
0.82(0.19, 3.45)
|
Government Employed
|
22
|
104
|
0.99(0.34, 2.87)
|
0.49(0.13, 1.83)
|
Others
|
5
|
24
|
1
|
1
|
Number of under-5 children
|
1
|
98
|
321
|
0.95(0.65, 1.38)
|
8.02(0.70, 91.88)
|
2
|
58
|
180
|
0.11(0.01, 0.99)
|
8.30(0.72, 95.37)
|
3
|
3
|
1
|
1
|
1
|
Average monthly income
|
<500
|
10
|
22
|
0.52(0.14, 1.94)
|
0.49(0.11, 2.41)
|
500-1000
|
106
|
279
|
0.62(0.21, 1.88)
|
0.79(0.19, 3.24)
|
1001-5000
|
39
|
184
|
1.11(0.35, 3.48)
|
1.21(0.35, 4.14)
|
>5000
|
4
|
17
|
1
|
1
|
Residence
|
Urban
|
33
|
181
|
2.06(1.35, 3.15)
|
0.26(0.09, 0.73)**
|
Rural
|
122
|
321
|
1
|
1
|
Child Age
|
2-12 Months
|
61
|
142
|
0.61(0.34, 1.09)
|
0.86(0.44, 1.65)
|
13-24 Months
|
20
|
68
|
0.89(0.44, 1.81)
|
1.13(0.52, 2.45)
|
25-36 Months
|
58
|
216
|
0.98(0.55, 1.74)
|
1.23(0.65, 2.33)
|
37-59 Months
|
20
|
76
|
1
|
1
|
*significant at (P<0.05),* *significant at (P<0.01), ***significant (P<0.001)
Determinant factors associated with healthcare-seeking behavior
The result of bivariate analysis revealed that educational status of caregiver, caregivers occupation, number of under-five children, monthly income, distance to the health facility, household residence, child age, a caregiver who had an experience of child death before, presence of diarrheal symptoms, presence of cough, diarrhea, and fever together and accesses of transportation were significantly associated with healthcare-seeking behavior and were a candidate for multivariable logistic regression, whereas the age of caregiver, marital status, household size, caregivers religion, sex of caregiver, presence of cough symptom, child sex and perceived severity of childhood illness by caregivers were not significant at p-value <0.25.
Moreover, the result of multivariable logistic regression analysis showed that experience of child death before [AOR=3.766; 95%CI: 1.726, 8.873], presence of diarrheal symptom [AOR=3.914; 95%CI: 2.043, 10.828] and accesses to transportation [AOR=3.352; 95%CI: 1.049, 10.710] were independent predictors of healthcare-seeking behavior of caregivers for common childhood illnesses. However, caregivers level of education, caregivers occupation, household monthly income, distance from a health facility, place of residence, number of under-five children, child age and presence of cough, diarrhea and fever symptoms together were not significantly associated with healthcare-seeking behavior of caregivers for common childhood illnesses in the multivariable analysis at p-value <0.05.
Table 5: Factors associated with healthcare seeking behavior in Efratana Gidim woreda, east Amhara, Ethiopia, 2020. (n=159)
Variables
|
Healthcare seeking
Yes No
|
COR (95%CI)
|
AOR (95% CI)
|
Educational Status
|
Illiterate
|
48
|
44
|
1.058(0.481, 2.328)
|
1.136(0.440, 2.936)
|
Elementary
|
18
|
16
|
0.159(0.034, 0.734)
|
0.218(0.024, 1.936)
|
Secondary
|
15
|
2
|
0.275(0.073, 1.029)
|
0.233(0.018, 3.046)
|
Higher
|
13
|
3
|
1
|
1
|
Occupation
|
Housewife
|
70
|
55
|
0.636(0.182, 2.224)
|
0.626(0.112, 3.506)
|
Merchant
|
6
|
6
|
0.283(0.090, 0.884)
|
0.452(0.045, 4.502)
|
Government Employed
|
18
|
4
|
1
|
1
|
Number of under-5 children
|
1
|
53
|
45
|
0.576(0.290, 1.141)
|
0.439(0.177, 1.084)
|
2
|
40
|
18
|
2.558(0.224, 29.156)
|
2.934(0.155, 55.627)
|
3
|
1
|
2
|
1
|
1
|
Average monthly income
|
<500
|
7
|
3
|
2.006(0.492, 8.178)
|
1.909(0.345, 10.561)
|
500-1000
|
55
|
51
|
0.805(0.174, 3.722)
|
0.681(0.077, 6.034)
|
1001-5000
|
29
|
10
|
0.778(0.056, 10.861)
|
3.398(0.102, 113.41)
|
>5000
|
3
|
1
|
1
|
1
|
Distance
|
|
|
|
|
< 5 km
|
74
|
44
|
1.90(0.926, 3.90)
|
1.084(0.441, 2.663)
|
> 5 km
|
20
|
21
|
1
|
1
|
Residence
|
|
|
|
|
Urban
|
26
|
7
|
2.971(1.201, 7.349)
|
0.175(0.009, 3.441)
|
Rural
|
68
|
58
|
1
|
1
|
Child Age
|
|
|
|
|
2-12 Months
|
36
|
25
|
0.830(0.290, 2.379)
|
1.087(0.281, 4.212)
|
13-24 Months
|
13
|
7
|
0.811(0.385, 1.711)
|
0.932(0.377, 2.305)
|
25-36 Months
|
38
|
20
|
2.312(0.824, 6.488)
|
3.624(0.994, 13.209)
|
37-59 Months
|
7
|
13
|
1
|
1
|
Experience of child death
|
Yes
|
30
|
5
|
5.625(2.048, 15.446)
|
3.766(1.726, 8.873)*
|
No
|
64
|
60
|
1
|
1
|
Diarrhea
|
|
|
|
|
Yes
|
53
|
19
|
3.130(1.598, 6.130)
|
3.914(2.04, 10.83)***
|
No
|
41
|
46
|
1
|
1
|
Cough, Diarrhea and Fever
|
Yes
|
13
|
3
|
3.133(0.855, 11.478)
|
1.396(0.233, 8.343)
|
No
|
81
|
62
|
1
|
1
|
Access of Transportation
|
Yes
|
41
|
9
|
4.813(2.134, 10.857)
|
3.352(1.049, 10.710)*
|
No
|
53
|
56
|
1
|
1
|
|
|
|
|
|
|
*significant at (P<0.05),* *significant at (P<0.01), ***significant at (P<0.001)