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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.


Adjusted association between maternal education and log-odds of health facility utilization for fever. Restricted cubic spline of association between maternal education (years) and the log-odds of health-care utilization for fever among children 6–59 months of age. The 95% confidence interval is represented by the gray area. Adjustment values of covariates include the median value or most prevalent category.
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fig2: Adjusted association between maternal education and log-odds of health facility utilization for fever. Restricted cubic spline of association between maternal education (years) and the log-odds of health-care utilization for fever among children 6–59 months of age. The 95% confidence interval is represented by the gray area. Adjustment values of covariates include the median value or most prevalent category.

Mentions: In multivariable logistic regression models, the characteristics most associated with health-care utilization across all illnesses (fever, diarrhea, and respiratory illness) were delivery of last child at a health-care facility, higher maternal education, and household ownership of a radio (Table 3). Notably, if the respondent had delivered her last child at a health facility, she had a roughly 2–4 times higher odds of seeking care for her child under question (not necessarily the last child delivered) at a health facility for fever, diarrhea, or respiratory illness (diarrhea: odds ratio [OR] = 1.93; 95% confidence interval [CI] = 1.10, 3.37; P = 0.021; fever: OR = 2.69; 95% CI = 1.64, 4.40; P < 0.001; and respiratory illness: OR = 4.43; 95% CI = 2.91, 9.01; P < 0.001). Higher maternal education (5 years versus 0 years) was associated with a roughly 1.5 times higher odds of seeking care at a health facility for all three illness categories, though the observed association fell short of statistical significance for respiratory illness. Additionally, these data revealed a nonlinear association between maternal education and seeking care for fever, with the greatest increase in odds between 0 and 2 years of education, then increasing again for each year above 6 years (Figure 2Figure 2.


Predictors of Health-Care Utilization Among Children 6 – 59 Months of Age in Zamb é zia Province, Mozambique
Adjusted association between maternal education and log-odds of health facility utilization for fever. Restricted cubic spline of association between maternal education (years) and the log-odds of health-care utilization for fever among children 6–59 months of age. The 95% confidence interval is represented by the gray area. Adjustment values of covariates include the median value or most prevalent category.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5303059&req=5

fig2: Adjusted association between maternal education and log-odds of health facility utilization for fever. Restricted cubic spline of association between maternal education (years) and the log-odds of health-care utilization for fever among children 6–59 months of age. The 95% confidence interval is represented by the gray area. Adjustment values of covariates include the median value or most prevalent category.
Mentions: In multivariable logistic regression models, the characteristics most associated with health-care utilization across all illnesses (fever, diarrhea, and respiratory illness) were delivery of last child at a health-care facility, higher maternal education, and household ownership of a radio (Table 3). Notably, if the respondent had delivered her last child at a health facility, she had a roughly 2–4 times higher odds of seeking care for her child under question (not necessarily the last child delivered) at a health facility for fever, diarrhea, or respiratory illness (diarrhea: odds ratio [OR] = 1.93; 95% confidence interval [CI] = 1.10, 3.37; P = 0.021; fever: OR = 2.69; 95% CI = 1.64, 4.40; P < 0.001; and respiratory illness: OR = 4.43; 95% CI = 2.91, 9.01; P < 0.001). Higher maternal education (5 years versus 0 years) was associated with a roughly 1.5 times higher odds of seeking care at a health facility for all three illness categories, though the observed association fell short of statistical significance for respiratory illness. Additionally, these data revealed a nonlinear association between maternal education and seeking care for fever, with the greatest increase in odds between 0 and 2 years of education, then increasing again for each year above 6 years (Figure 2Figure 2.

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&ndash;59 months of age with fever, diarrhea, and respiratory symptoms in Zamb&eacute;zia 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.