Seasonal and geographic differences in treatment-seeking and household cost of febrile illness among children in Malawi


Ewing, VL; Lalloo, DG; Phiri, KS; Roca-Feltrer, A; Mangham, LJ; Sanjoaquin, MA; (2011) Seasonal and geographic differences in treatment-seeking and household cost of febrile illness among children in Malawi. Malaria Journal, 10 (1). p. 32. ISSN 1475-2875 DOI: https://doi.org/10.1186/1475-2875-10-32

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Abstract

Background: Households in malaria endemic countries experience considerable costs in accessing formal health facilities because of childhood malaria. The Ministry of Health in Malawi has defined certain villages as hard-to-reach on the basis of either their distance from health facilities or inaccessibility. Some of these villages have been assigned a community health worker, responsible for referring febrile children to a health facility. Health facility utilization and household costs of attending a health facility were compared between individuals living near the district hospital and those in hard-to-reach villages. Methods: Two cross-sectional household surveys were conducted in the Chikhwawa district of Malawi; one during each of the wet and dry seasons. Half the participating villages were located near the hospital, the others were in areas defined as hard-to-reach. Data were collected on attendance to formal health facilities and economic costs incurred due to recent childhood febrile illness. Results: Those living in hard-to-reach villages were less likely to attend a formal health facility compared to those living near the hospital (Dry season: OR 0.35, 95%CI0.18-0.67; Wet season: OR 0.46, 95% CI0.27-0.80). Analyses including community health workers (CHW) as a source of formal health-care decreased the strength of this relationship, and suggested that consulting a CHW may reduce attendance at health facilities, even if indicated. Although those in hard-to-reach villages were still less likely to attend in both the dry (OR 0.53, 95%CI 0.25-1.11) and wet (OR 0.60, 95% CI 0.37-0.98) seasons. Household costs for those who attended a health facility were greater for those in HTR villages (Dry: USD5.24; Wet: USD5.60) than for those living near the district hospital (Dry: USD3.45; Wet: USD4.46). Conclusion: Those living in hard-to-reach areas were less likely to attend a health facility for a childhood febrile event and experienced greater associated household costs. Consulting CHWs was infrequent, but appeared to reduce attendance at a health facility, even when indicated. Health service planners must consider geographic and financial barriers to accessing public health facilities in designing appropriate interventions.

Item Type: Article
Keywords: SOCIOECONOMIC-STATUS, CARE SEEKING, HEALTH-CARE, MALARIA, DISTRICT, INEQUITIES, TANZANIA, BEHAVIOR, SYSTEMS, BURDEN, SOCIOECONOMIC-STATUSCARE SEEKINGHEALTH-CAREMALARIADISTRICTINEQUITIESTANZANIABEHAVIORSYSTEMSBURDEN
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Research Centre: Malaria Centre
PubMed ID: 21303538
Web of Science ID: 288812600006
URI: http://researchonline.lshtm.ac.uk/id/eprint/898

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