Cross Sectional Survey of Care Seeking For Acute Respiratory Illness in Children Under 5 Years in Rural Kenya

Abstract

Acute respiratory infection (ARI) is a leading cause of childhood morbidity and mortality in developing countries. In Kenya, diagnosis and treatment of ARI remains predominantly health facility based. This presumes that caretakers can recognize ARI symptoms promptly and make a decision to take the child to an appropriate health facility for treatment. Unfortunately, these presumptions have not been assessed. This study sought to establish determinants of health care seeking among caretakers of children under five years (CU5) of age with ARI. An analytic cross sectional survey was carried out in Githunguri Sub - County of Kiambu County. Households with CU5 who had recently suffered an episode of ARI were enrolled. Structured questionnaires, focused group discussions and key informant guides were used to gather information. Structured questionnaires were administered to caretakers to obtain information on socio-demographics, knowledge and health seeking practices. Bivariate and multivariate analysis was carried out with a p value of < 0.05. From 438 households sampled, 323 (73.7%) had CU5 in their households. Out of these, 240 (74.3%) of the children had an episode of ARI in the preceding 2 weeks. The mean age of the children was 29.2 months, with male to female ratio of 1:1. The mean mothers’ age was 29.4 years, 71.2% were married, 54.8% had secondary education and 66.6% were of Christian-protestants faith and (90.0%) were in informal employment. Poor knowledge of pneumonia was documented in 92.5% of caretakers. One hundred and forty nine (62.1%) caretakers had delayed health facility consultation for ARI. The main factors associated with delayed facility consultation were poor knowledge of symptoms (p = 0.007) long distance to the nearest health facility (p = 0.002), means of transport used to access the nearest health facility (p = 0.001) and previous high expenditure at health facility (p = 0.011). On logistic regression, the main factors that independently determined delayed facility consultation were long waiting time (>1hour) before service provision (p = 0.001), use of a motorbike to access the nearest health facility (p = 0.001) and traveling for 4 - 4.9 kilo meters to the nearest health facility (p = 0.002). Travelling for long distance and long waiting time before service provision during the previous facility visit were the main determinants of delayed facility consultations. The study recommends increased sensitization on symptom recognition among caretakers, and intensified efforts to reduce turn-around time during health facility consultations in order to minimize delays in health facility consultation.