Timely health care seeking and first source of care for acute febrile illness in children in Hawassa, southern Ethiopia

Techalew Shimelis; Gill Schierhout; Birkneh Tilahun Tadesse; Sabine Dittrich; John A Crump; John M Kaldor; Susana Vaz Nery

doi:10.1371/journal.pone.0269725

Timely health care seeking and first source of care for acute febrile illness in children in Hawassa, southern Ethiopia

PLoS One. 2022 Jun 9;17(6):e0269725. doi: 10.1371/journal.pone.0269725. eCollection 2022.

Authors

Techalew Shimelis^{1

2}, Gill Schierhout³, Birkneh Tilahun Tadesse², Sabine Dittrich^{4

5}, John A Crump⁶, John M Kaldor¹, Susana Vaz Nery¹

Affiliations

¹ Kirby Institute, University of New South Wales, Sydney, Australia.
² College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
³ The George Institute for Global Health, University of New South Wales, Sydney, Australia.
⁴ Foundation for Innovative New Diagnostics, Geneva, Switzerland.
⁵ Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
⁶ Centre for International Health, University of Otago, Dunedin, New Zealand.

Abstract

Background: Timely health care seeking with access to quality health care are crucial to improve child survival. We conducted a study which aimed to identify factors influencing timely health care seeking and choice of first source of health care in Ethiopia.

Methods: A total of 535 caregivers who sought health care for febrile children aged under 5 years at a tertiary hospital, and one urban and two rural health centres in Hawassa, southern Ethiopia were recruited to participate in the study from August to November 2019. Caregivers were interviewed using pretested structured questionnaires on socio-demographic and clinical factors to identify associations with health care seeking practice and first source of care, and reasons for particular practices. Delayed care seeking was defined as seeking care from a health facility after 24 hours of onset of fever.

Results: Of 535 caregivers who participated, 271 (50.7%) had sought timely health care; 400 (74.8%) utilized a primary health care (PHC) facility as first source; and 282 (52.7%) bypassed the nearest PHC facility. Rural residents (adjusted odds ratio (AOR) 1.85; 95% CI 1.11-3.09), and those who reported cough (AOR 1.87; 95% CI 1.20-2.93) as a reason for consultation were more likely to delay seeking health care. While caregivers were less likely delayed for children aged 24-35 months (AOR 0.50; 95% CI 0.28-0.87) compared to infants. Utilizing higher-level hospitals as the first source of care was less frequent among rural residents (AOR 0.15; 95% CI 0.06-0.39) and in those with no formal education (AOR 0.03; 95% CI 0.01-0.27). Those having a longer travel time to the provider (AOR 2.11; 95% CI 1.09-4.08) more likely utilized higher hospitals.

Conclusion: We identified a need to improve timely health seeking among rural residents, infants, and those presenting with respiratory symptoms. Improvements may be achieved by educating communities on the need of early care seeking, and ensuring the communities members' expectations of services at each level consistent with the services capacity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Cross-Sectional Studies
Delivery of Health Care
Ethiopia / epidemiology
Fever / epidemiology
Fever / therapy
Health Facilities*
Humans
Infant
Patient Acceptance of Health Care*

Grants and funding

Hawassa University, College of Medicine and Health Sciences, provided material support for this research work. A small financial support was also obtained from Kirby Institute, UNSW, to support doctoral student. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Techalew Shimelis received a PhD scholarship (University International Postgraduate Award) administered by UNSW Sydney, and salary from Hawassa University. John M Kaldor is supported by a Fellowship from the NHMRC and receives salary from UNSW. Susana Vaz Nery and Gill Schierhout receive salary from UNSW.