Care-seeking behaviour among febrile children under five in Togo

BACKGROUND: Fever is one of the warning signs of poor health in children. Care-seeking in febrile children is importance in reducing child deaths and morbidity. This care-seeking by parents in children with fever is however relatively low in sub-Sahara Africa. The aim of this study is to improve understanding of the behaviour of caregivers in seeking care for children under five with fever and to identify associated modifiable risk factors in Togo. METHODS: Data from a 2013–2014 cross-sectional nationally representative malaria indicator survey was used. Advice or care-seeking is defined as any child under 5 years of age with fever in the two weeks prior to the interview for whom advice or treatment was sought in a public medical area, private medical area, store, market, or from an itinerant medicine seller. Univariate and multivariate logistic regression analysis were performed using Generalized Linear Models. RESULTS: A total of 1359 febrile children out of 6529 children under five were enrolled. Care had been sought in 38.9% of cases. In multivariate analysis, independent risk factors associated with formal care seeking were accessibility to the nearest health center (aOR = 1.52, 95% CI [1.18–1.95], mother's education level secondary and above (aOR = 1.85, 95% [1.32–2.59]), mothers who identified as belonging to animist/traditionalist religions compared to mothers who belonged to a formal religion (catholic (aOR = 2. 28, 95% [1.55–3.37]), Muslim (aOR = 2.41, 95% [1.67–3.47]), and Protestant (aOR = 1.9, 95% [1.37–2.65]), Maritime region (aOR = 0.49, 95% [0.29–0.82]) compared to Lome commune. CONCLUSION: Interventions should specifically target women with limited education, not identifying as part of an official church and at longer distance from health center.