Malaria Journal | |
Seasonal and geographic differences in treatment-seeking and household cost of febrile illness among children in Malawi | |
Research | |
David G Lalloo1  Lindsay J Mangham2  Victoria L Ewing3  Arantxa Roca-Feltrer3  Miguel A SanJoaquin3  Kamija S Phiri4  | |
[1] Liverpool School of Tropical Medicine, Liverpool, UK;London School of Hygiene, Tropical Medicine, London, UK;Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi;Liverpool School of Tropical Medicine, Liverpool, UK;Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi;University of Malawi, College of Medicine, Blantyre, Malawi; | |
关键词: Malaria; Health Facility; Community Health Worker; Febrile Episode; Febrile Child; | |
DOI : 10.1186/1475-2875-10-32 | |
received in 2010-09-20, accepted in 2011-02-08, 发布年份 2011 | |
来源: Springer | |
【 摘 要 】
BackgroundHouseholds 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.MethodsTwo 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.ResultsThose 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).ConclusionThose 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.
【 授权许可】
CC BY
© Ewing et al; licensee BioMed Central Ltd. 2011
【 预 览 】
Files | Size | Format | View |
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RO202311100079216ZK.pdf | 337KB | download |
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