Cargando…
Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda
BACKGROUND: Over half of under-five deaths occur in sub-Saharan Africa and appropriate, timely, quality care is critical for saving children’s lives. This study describes the context surrounding children’s deaths from the time the illness was first noticed, through the care-seeking patterns leading...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761861/ https://www.ncbi.nlm.nih.gov/pubmed/29320556 http://dx.doi.org/10.1371/journal.pone.0190739 |
_version_ | 1783291603233800192 |
---|---|
author | Kagabo, Daniel M. Kirk, Catherine M. Bakundukize, Benjamin Hedt-Gauthier, Bethany L. Gupta, Neil Hirschhorn, Lisa R. Ingabire, Willy C. Rouleau, Dominique Nkikabahizi, Fulgence Mugeni, Catherine Sayinzoga, Felix Amoroso, Cheryl L. |
author_facet | Kagabo, Daniel M. Kirk, Catherine M. Bakundukize, Benjamin Hedt-Gauthier, Bethany L. Gupta, Neil Hirschhorn, Lisa R. Ingabire, Willy C. Rouleau, Dominique Nkikabahizi, Fulgence Mugeni, Catherine Sayinzoga, Felix Amoroso, Cheryl L. |
author_sort | Kagabo, Daniel M. |
collection | PubMed |
description | BACKGROUND: Over half of under-five deaths occur in sub-Saharan Africa and appropriate, timely, quality care is critical for saving children’s lives. This study describes the context surrounding children’s deaths from the time the illness was first noticed, through the care-seeking patterns leading up to the child’s death, and identifies factors associated with care-seeking for these children in rural Rwanda. METHODS: Secondary analysis of a verbal and social autopsy study of caregivers who reported the death of a child between March 2013 to February 2014 that occurred after discharge from the child’s birth facility in southern Kayonza and Kirehe districts in Rwanda. Bivariate analyses using Fisher’s exact tests were conducted to identify child, caregiver, and household factors associated with care-seeking from the formal health system (i.e., community health worker or health facility). Factors significant at α = 0.10 significance level were considered for backwards stepwise multivariate logistic regression, stopping when remaining factors were significantly associated with care-seeking at α = 0.05 significance level. RESULTS: Among the 516 eligible deaths among children under-five, 22.7% (n = 117) did not seek care from the health system. For those who did, the most common first point of contact was community health workers (45.8%). In multivariate logistic regression, higher maternal education (OR = 3.36, 95% CI: 1.89, 5.98), having diarrhea (OR = 4.21, 95%CI: 1.95, 9.07) or fever (OR = 2.03, 95%CI: 1.11, 3.72), full household insurance coverage (3.48, 95%CI: 1.79, 6.76), and longer duration of illness (OR = 22.19, 95%CI: 8.88, 55.48) were significantly associated with formal care-seeking. CONCLUSION: Interventions such as community health workers and insurance promote access to care, however a gap remains as many children had no contact with the health system prior to death and those who sought formal care still died. Further efforts are needed to respond to urgent cases in communities and further understand remaining barriers to accessing appropriate, quality care. |
format | Online Article Text |
id | pubmed-5761861 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-57618612018-01-23 Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda Kagabo, Daniel M. Kirk, Catherine M. Bakundukize, Benjamin Hedt-Gauthier, Bethany L. Gupta, Neil Hirschhorn, Lisa R. Ingabire, Willy C. Rouleau, Dominique Nkikabahizi, Fulgence Mugeni, Catherine Sayinzoga, Felix Amoroso, Cheryl L. PLoS One Research Article BACKGROUND: Over half of under-five deaths occur in sub-Saharan Africa and appropriate, timely, quality care is critical for saving children’s lives. This study describes the context surrounding children’s deaths from the time the illness was first noticed, through the care-seeking patterns leading up to the child’s death, and identifies factors associated with care-seeking for these children in rural Rwanda. METHODS: Secondary analysis of a verbal and social autopsy study of caregivers who reported the death of a child between March 2013 to February 2014 that occurred after discharge from the child’s birth facility in southern Kayonza and Kirehe districts in Rwanda. Bivariate analyses using Fisher’s exact tests were conducted to identify child, caregiver, and household factors associated with care-seeking from the formal health system (i.e., community health worker or health facility). Factors significant at α = 0.10 significance level were considered for backwards stepwise multivariate logistic regression, stopping when remaining factors were significantly associated with care-seeking at α = 0.05 significance level. RESULTS: Among the 516 eligible deaths among children under-five, 22.7% (n = 117) did not seek care from the health system. For those who did, the most common first point of contact was community health workers (45.8%). In multivariate logistic regression, higher maternal education (OR = 3.36, 95% CI: 1.89, 5.98), having diarrhea (OR = 4.21, 95%CI: 1.95, 9.07) or fever (OR = 2.03, 95%CI: 1.11, 3.72), full household insurance coverage (3.48, 95%CI: 1.79, 6.76), and longer duration of illness (OR = 22.19, 95%CI: 8.88, 55.48) were significantly associated with formal care-seeking. CONCLUSION: Interventions such as community health workers and insurance promote access to care, however a gap remains as many children had no contact with the health system prior to death and those who sought formal care still died. Further efforts are needed to respond to urgent cases in communities and further understand remaining barriers to accessing appropriate, quality care. Public Library of Science 2018-01-10 /pmc/articles/PMC5761861/ /pubmed/29320556 http://dx.doi.org/10.1371/journal.pone.0190739 Text en © 2018 Kagabo et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Kagabo, Daniel M. Kirk, Catherine M. Bakundukize, Benjamin Hedt-Gauthier, Bethany L. Gupta, Neil Hirschhorn, Lisa R. Ingabire, Willy C. Rouleau, Dominique Nkikabahizi, Fulgence Mugeni, Catherine Sayinzoga, Felix Amoroso, Cheryl L. Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda |
title | Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda |
title_full | Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda |
title_fullStr | Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda |
title_full_unstemmed | Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda |
title_short | Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda |
title_sort | care-seeking patterns among families that experienced under-five child mortality in rural rwanda |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761861/ https://www.ncbi.nlm.nih.gov/pubmed/29320556 http://dx.doi.org/10.1371/journal.pone.0190739 |
work_keys_str_mv | AT kagabodanielm careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda AT kirkcatherinem careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda AT bakundukizebenjamin careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda AT hedtgauthierbethanyl careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda AT guptaneil careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda AT hirschhornlisar careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda AT ingabirewillyc careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda AT rouleaudominique careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda AT nkikabahizifulgence careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda AT mugenicatherine careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda AT sayinzogafelix careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda AT amorosocheryll careseekingpatternsamongfamiliesthatexperiencedunderfivechildmortalityinruralrwanda |