Understanding where parents take their sick children and why it matters: a multi-country analysis

BACKGROUND: Developing effective context-specific strategies to ensure that a high proportion of children receive timely and appropriate care requires knowing the source from which care is sought. Although Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) collect such data in disaggregated form, they are not made available in the standard DHS and MICS reports. METHODS: Secondary data analysis was done on 42 DHS and MICS surveys conducted since 2005 for care seeking for acute respiratory illness (DHS and MICS), diarrhea (DHS only), and fever (DHS only), disaggregating by urban-rural settings. Eight categories were used for source of care. Stata, version 12, was used for the analysis. RESULTS: Patterns varied considerably, with care seeking in most of sub-Saharan Africa predominantly from public-sector providers, in South Asia predominantly from the private sector, and in Southeast Asia from a mix of public and private sources. Community health workers were not an important source of care. CONCLUSIONS: Variation in care-seeking patterns has implications for effective strategy, as described in more detail in 5 country examples from Asia and Africa. The analysis also suggests that it may be inappropriate to focus program efforts on community health workers to the exclusion of more widely used sources of care. The authors argue that, in order to ensure sounder program approaches, disaggregated care-seeking data should be routinely included in DHS and MICS reports. Finally, the authors call for more data on actual care provided in order to improve quality of care.