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Predictors of Health-Care Utilization Among Children 6 – 59 Months of Age in Zamb é zia Province, Mozambique

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ABSTRACT

Globally, approximately 5.9 million children under 5 years of age died in 2015, a reduction of over 50% since 1990. Millennium Development Goal 4 established the goal of reducing child mortality by two-thirds by 2015. Multiple countries have surpassed this goal; however, regional and within-country inequities exist. We sought to study determinants of health-care utilization among children 6–59 months of age with fever, diarrhea, and respiratory symptoms in Zambézia Province, Mozambique. We conducted a population-based cross-sectional survey of female heads of household between April and May 2014. Mobile teams conducted interviews in 262 enumeration areas, with three distinct districts being oversampled for improved precision. Descriptive statistics and logistic regression using Stata 13.1 and R 3.2.2 were used to examine factors associated with health-care utilization. A total of 2,317 children were evaluated in this study. Mothers' median age was 26 years, whereas child median age was 24 months. The proportion of children reporting fever, diarrhea, or respiratory illness in the prior 30 days was 44%, 22%, and 22%, respectively. Health-care utilization varied with 65% seeking health care for fever, compared with 57% for diarrhea and 25% for respiratory illness. In multivariable logistic regression, the characteristics most associated with health-care utilization across illnesses were delivery of last child at a facility, higher maternal education, and household ownership of a radio. The decision or ability to use health care is a multifaceted behavior swayed by societal norms, values, socioeconomics, and perceived need. Recognizing the predictors of a particular population may offer useful information to increase uptake in health-care services.

No MeSH data available.


Map of Mozambique highlighting Zambézia Province and Maputo Province, with enumeration areas enlarged. Charlotte Buehler; March 3, 2016; Vanderbilt Institute for Global Health; Projection: WGS 1984 Web Mercator Auxiliary Sphere. Permission has been granted by the copy-right holder for publication of this figure in an open access journal.
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fig1: Map of Mozambique highlighting Zambézia Province and Maputo Province, with enumeration areas enlarged. Charlotte Buehler; March 3, 2016; Vanderbilt Institute for Global Health; Projection: WGS 1984 Web Mercator Auxiliary Sphere. Permission has been granted by the copy-right holder for publication of this figure in an open access journal.

Mentions: In 2015, Mozambique ranked 180 of 188 countries on the United Nations Development Program Human Development Index,5 having the 23rd highest national under-five mortality rate at 79 per 1,000 live births.1,6 This rate has been falling over time with a 2005 national under-five mortality estimated at 138 per 1,000 live births compared with 219 per 1,000 live births in 1997.6–9 Although Mozambique appears to have surpassed its 2015 national under-five mortality target for MDG 4, substantial regional differences persist.10 Economic activity, infrastructure, and basic services are highly concentrated around the capital Maputo, which is located in the southernmost part of the country. In 2011, Maputo Province had the lowest under-five mortality (96 per 1,000 live births) compared with Zambézia Province (142 per 1,000 live births), which is among the highest risk provinces in Mozambique for under-five mortality (Figure 1Figure 1.


Predictors of Health-Care Utilization Among Children 6 – 59 Months of Age in Zamb é zia Province, Mozambique
Map of Mozambique highlighting Zambézia Province and Maputo Province, with enumeration areas enlarged. Charlotte Buehler; March 3, 2016; Vanderbilt Institute for Global Health; Projection: WGS 1984 Web Mercator Auxiliary Sphere. Permission has been granted by the copy-right holder for publication of this figure in an open access journal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC5303059&req=5

fig1: Map of Mozambique highlighting Zambézia Province and Maputo Province, with enumeration areas enlarged. Charlotte Buehler; March 3, 2016; Vanderbilt Institute for Global Health; Projection: WGS 1984 Web Mercator Auxiliary Sphere. Permission has been granted by the copy-right holder for publication of this figure in an open access journal.
Mentions: In 2015, Mozambique ranked 180 of 188 countries on the United Nations Development Program Human Development Index,5 having the 23rd highest national under-five mortality rate at 79 per 1,000 live births.1,6 This rate has been falling over time with a 2005 national under-five mortality estimated at 138 per 1,000 live births compared with 219 per 1,000 live births in 1997.6–9 Although Mozambique appears to have surpassed its 2015 national under-five mortality target for MDG 4, substantial regional differences persist.10 Economic activity, infrastructure, and basic services are highly concentrated around the capital Maputo, which is located in the southernmost part of the country. In 2011, Maputo Province had the lowest under-five mortality (96 per 1,000 live births) compared with Zambézia Province (142 per 1,000 live births), which is among the highest risk provinces in Mozambique for under-five mortality (Figure 1Figure 1.

View Article: PubMed Central - PubMed

ABSTRACT

Globally, approximately 5.9 million children under 5 years of age died in 2015, a reduction of over 50% since 1990. Millennium Development Goal 4 established the goal of reducing child mortality by two-thirds by 2015. Multiple countries have surpassed this goal; however, regional and within-country inequities exist. We sought to study determinants of health-care utilization among children 6–59 months of age with fever, diarrhea, and respiratory symptoms in Zambézia Province, Mozambique. We conducted a population-based cross-sectional survey of female heads of household between April and May 2014. Mobile teams conducted interviews in 262 enumeration areas, with three distinct districts being oversampled for improved precision. Descriptive statistics and logistic regression using Stata 13.1 and R 3.2.2 were used to examine factors associated with health-care utilization. A total of 2,317 children were evaluated in this study. Mothers' median age was 26 years, whereas child median age was 24 months. The proportion of children reporting fever, diarrhea, or respiratory illness in the prior 30 days was 44%, 22%, and 22%, respectively. Health-care utilization varied with 65% seeking health care for fever, compared with 57% for diarrhea and 25% for respiratory illness. In multivariable logistic regression, the characteristics most associated with health-care utilization across illnesses were delivery of last child at a facility, higher maternal education, and household ownership of a radio. The decision or ability to use health care is a multifaceted behavior swayed by societal norms, values, socioeconomics, and perceived need. Recognizing the predictors of a particular population may offer useful information to increase uptake in health-care services.

No MeSH data available.