Relationship between symptoms, barriers to care and healthcare utilisation among children under five in rural Mali.

Autor: Treleaven E; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA., Whidden C; Muso, Bamako, Mali.; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK., Cole F; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA., Kayentao K; Muso, Bamako, Mali.; Malaria Research & Training Centre, University of Bamako, Bamako, Mali., Traoré MB; Muso, Bamako, Mali., Diakité D; Muso, Bamako, Mali., Sidibé S; Muso, Bamako, Mali., Lin TK; Institute for Health & Aging, University of California, San Francisco, CA, USA., Boettiger D; Institute for Health & Aging, University of California, San Francisco, CA, USA.; Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Cissouma S; Mali Regional Health Directorate, Bankass, Mali., Sanogo V; Division of Prevention and Case Management, National Malaria Control Programme, Bamako, Mali., Padian N; Institute for Health & Aging, University of California, San Francisco, CA, USA., Johnson A; Muso, Bamako, Mali.; Department of Medicine, University of California, San Francisco, CA, USA., Liu J; Institute for Health & Aging, University of California, San Francisco, CA, USA.
Jazyk: angličtina
Zdroj: Tropical medicine & international health : TM & IH [Trop Med Int Health] 2021 Aug; Vol. 26 (8), pp. 943-952. Date of Electronic Publication: 2021 May 14.
DOI: 10.1111/tmi.13592
Abstrakt: Objectives: To identify social and structural barriers to timely utilisation of qualified providers among children under five years in a high-mortality setting, rural Mali and to analyse how utilisation varies by symptom manifestation.
Methods: Using baseline household survey data from a cluster-randomised trial, we assessed symptom patterns and healthcare trajectories of 5117 children whose mothers reported fever, diarrhoea, bloody stools, cough and/or fast breathing in the preceding two weeks. We examine associations between socio-demographic factors, symptoms and utilisation outcomes in mixed-effect logistic regressions.
Results: Almost half of recently ill children reported multiple symptoms (46.2%). Over half (55.9%) received any treatment, while less than one-quarter (21.7%) received care from a doctor, nurse, midwife, trained community health worker or pharmacist within 24 h of symptom onset. Distance to primary health facility, household wealth and maternal education were consistently associated with better utilisation outcomes. While children with potentially more severe symptoms such as fever and cough with fast breathing or diarrhoea with bloody stools were more likely to receive any care, they were no more likely than children with fever to receive timely care with a qualified provider.
Conclusions: Even distances as short as 2-5 km significantly reduced children's likelihood of utilising healthcare relative to those within 2 km of a facility. While children with symptoms indicative of pneumonia and malaria were more likely to receive any care, suggesting mothers and caregivers recognised potentially severe illness, multiple barriers to care contributed to delays and low utilisation of qualified providers, illustrating the need for improved consideration of barriers.
(© 2021 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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