Patterns of care seeking and treatment for sick children in Bougouni District, Mali
Background. Mali has one of the highest rates of under-five child mortality in the world; many children die from preventable or treatable childhood illness. This dissertation examines families' practices in treating common childhood illnesses.
Methods. As part of a operational research study examining zinc for childhood diarrhea, household surveys were carried out among caretakers of children sick in the previous 2 weeks; these caretakers were asked questions regarding their child's signs and symptoms of illness, as well as what treatments were administered and what sources of care were visited for their child's illness.
Results. Home practices for sick children were generally inappropriate and levels of care seeking to government-sanctioned sources of care were low, while use of the unauthorized private sector was high. The reported use of antibiotics for sick children is elevated; with most of these treatments obtained through the unauthorized private sector. Among children with diarrhea in the previous 2 weeks, only 9% were reported as having received pre-packaged oral rehydration solution. A multi-level logistic regression model was fit to assess both individual and village-level factors that influenced utilization of government-sanctioned health facilities. Caretakers' education, economic status of the household, distance to the health facility, and the child's symptoms significantly influenced the use of health facilities. At the village level, aggregate maternal education, considered a proxy for women's empowerment, and aggregate transportation resources were related to a sick child receiving care at a health facility.
Conclusions. The results of this study demonstrate that coverage of interventions to reduce child mortality is low in this setting and that families' treatment of childhood illness is frequently not appropriate. In order to improve treatment and care seeking practices in southern Mali, consideration should be given to (1) introduction of zinc and new ORS formulations, (2) strengthening of community health systems, (3) engagement and regulation of the private sector, and (4) subsidy of treatment and care from public health facilities.