Care-seeking
Recognize when sick children need treatment outside the home and seek care from appropriate providers.
It is remarkable that many of the children who die or develop severe illness have not been taken to a health facility—often without seeking any advice from an appropriate provider—or have been taken with much delay. An IMCI (Integrated management of childhood illness) health facility survey conducted in Sudan in 2002 found that 68% of caretakers who had taken their children to a health facility had waited more than 24 hours before seeking care, from the time they had recognised that their child had a breathing problem. Caretaker knowledge about the signs that should prompt them to seek consultation was low.
Various factors determine health seeking behaviour and are likely to interact with each other in the family decision-making process, eventually resulting in the choice of care and providers. These factors are related to the characteristics of the:
a) child (e.g. age, sex, birth order);
b) child caretakers (e.g. education, ethnic group, religion, family role and marital status, economic resources, social bonds with the community and providers);
c) child illness (e.g. caretaker recognition of symptoms and perceived severity of the illness and its causes—cultural “illness categories”);
d) health services (e.g., geographical accessibility, perceived quality of services and communication between caretakers and providers, costs).
When care is sought and sought timely, the outcome is influenced by health care providers’ skills to correctly identify severe illness and provide appropriate care timely, including emergency care, whether at the referring primary health care unit or referral facility.
Before increasing the demand for services by promoting care-seeking, efforts should be made to improve access to and quality of child health services, for these to be responsive to the needs and expectations of the community.
The determinants of health seeking behaviour and sources of care most commonly sought should be considered when designing interventions to improve care-seeking.
The rich mine of information from the many focussed ethnographic studies and household surveys available in most countries should guide those interventions.
Health communication efforts should emphasise those key signs, symptoms and illness entities that caretakers are able to recognise but of which they fail to appreciate the severity or importance.
Related links:
IMCI health facility survey, Sudan, 2002
