Trop Med Int Health. 2010 Jan 11.
Access to a health facility and care-seeking for danger signs in children: before and after a community-based intervention in Lusaka, Zambia.
Sasaki S, Fujino Y, Igarashi K, Tanabe N, Muleya CM, Suzuki H. Department of Infectious Disease Control and International Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Japan.
Objective – To assess the association of accessibility to a health facility with caregivers’ care-seeking practices for children with danger signs before and after community-based intervention in Lusaka, Zambia.
Method – Health education on childhood danger signs was started in September 2003 at the monthly Growth Monitoring Program Plus (GMP+) service through various channels of health talk and one-on-one communication in a peri-urban area of Lusaka. Two repeated surveys were conducted: in 2003 to collect baseline data before the intervention and in 2006 for 3-year follow-up data. Caregivers who had perceived one or more danger signs in their children within 2 months of the surveys were eligible for the analysis. The association between appropriate and timely care-seeking practices and socio-demographic and socio-economic factors, attendance at community-based intervention and the distance to a health facility was examined with logistic regression analysis.
Results – The percentage of caregivers immediately seeking care from health professionals increased from 56.1% (106/189) at baseline to 65.8% (148/225) at follow-up 3 years later (OR = 1.51, P < 0.05). Long distance to the health facility and low-household income negatively influenced caregivers’ appropriate and timely care-seeking practices at baseline, but 3 years later, after the implementation of a community-based intervention, distance and household income were not significantly related to caregivers’ care-seeking practices. Conclusion Poor accessibility to health facilities was a significant barrier to care-seeking in a peri-urban area. However, when caregivers are properly educated about danger signs and appropriate responses through community-based intervention, this barrier can be overcome through behavioural change in caregivers.
