To examine patterns of seeking care for gravely ill infants and children, we studied all deaths in children under 5 in 10,000 households in Indramayu, West Java, Indonesia, between July 1, 1991, and Dec 31, 1992. 141 deaths were identified (mortality rate 80.7 per 1000), of which 139 were due to causes other than trauma. No treatment of any kind was sought outside the home for 30 (22%) of the children who died from natural causes, and for 59 (42%) others only a traditional healer or other source of non-western medical advice was consulted. Whether or not a mother sought western medical care was strongly associated with the age of the child, the duration of the terminal illness, the previous attendance of the mother at a community-based maternal-and-child-health facility, and the mother's response to a prospectively asked question about what care should be sought for a hypothetical 1-month-old baby with signs of severe pneumonia. Household income, maternal age, and education, and distance between home and government health post were not associated with whether or not western medical care was sought.
PIP: Between July 1991 and December 1992, in Indramaya, West Java, Indonesia, trained community workers administered a questionnaire to mothers who experienced a death of a child under 5 years old during the study period (total deaths, 141) to study patterns of seeking care for gravely ill infants and children. The workers interviewed most mothers within 7 days of the child death. During this time, the neonatal mortality rate was 26.7, postneonatal mortality was 47.6, overall infant mortality was 74.3, and overall under-5 mortality was 80.7. Trauma was responsible for 2 deaths. The remaining causes of death were illness. Among these, 46% took place within the first 59 days of life. Duration of terminal illness varied from a few hours to more than 2 weeks. Families sought either just care from Western medical practitioner or a Western medical practitioner and a traditional healer in 36% of deaths due to illness. They sought a traditional healer and/or other people not trained in Western medicine in 42.4% of cases. They did not seek any care in the e remaining 21.6% of cases. 77% of the mothers of these cases believed the child's death was God's will. Seeking care, regardless of traditional or Western care, was positively linked to child's age (e.g., adjusted odds ration [AOR] = 15 for 3-5 years olds; p = .007); duration of illness (AOR = 2.8; p = .05); mother's attendance during the last 3 months at the once a month maternal and child health activity of growth monitoring, training in oral rehydration, and child immunizations called posyandu (AOR = 3.5; p = .03); and mother's response to the scenario of a 1 = month old infant with severe pneumonia (AOR = 2.6 for would seek Western care; p = .05).