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. 2018 Jan 10;13(1):e0190739.
doi: 10.1371/journal.pone.0190739. eCollection 2018.

Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda

Daniel M Kagabo  1 , Catherine M Kirk  1 , Benjamin Bakundukize  2 , Bethany L Hedt-Gauthier  1   3 , Neil Gupta  1   4 , Lisa R Hirschhorn  5 , Willy C Ingabire  1 , Dominique Rouleau  1 , Fulgence Nkikabahizi  2 , Catherine Mugeni  6 , Felix Sayinzoga  6 , Cheryl L Amoroso  1
Affiliations

Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda

Daniel M Kagabo et al. PLoS One. .

Abstract

Background: Over half of under-five deaths occur in sub-Saharan Africa and appropriate, timely, quality care is critical for saving children's lives. This study describes the context surrounding children's deaths from the time the illness was first noticed, through the care-seeking patterns leading up to the child's death, and identifies factors associated with care-seeking for these children in rural Rwanda.

Methods: Secondary analysis of a verbal and social autopsy study of caregivers who reported the death of a child between March 2013 to February 2014 that occurred after discharge from the child's birth facility in southern Kayonza and Kirehe districts in Rwanda. Bivariate analyses using Fisher's exact tests were conducted to identify child, caregiver, and household factors associated with care-seeking from the formal health system (i.e., community health worker or health facility). Factors significant at α = 0.10 significance level were considered for backwards stepwise multivariate logistic regression, stopping when remaining factors were significantly associated with care-seeking at α = 0.05 significance level.

Results: Among the 516 eligible deaths among children under-five, 22.7% (n = 117) did not seek care from the health system. For those who did, the most common first point of contact was community health workers (45.8%). In multivariate logistic regression, higher maternal education (OR = 3.36, 95% CI: 1.89, 5.98), having diarrhea (OR = 4.21, 95%CI: 1.95, 9.07) or fever (OR = 2.03, 95%CI: 1.11, 3.72), full household insurance coverage (3.48, 95%CI: 1.79, 6.76), and longer duration of illness (OR = 22.19, 95%CI: 8.88, 55.48) were significantly associated with formal care-seeking.

Conclusion: Interventions such as community health workers and insurance promote access to care, however a gap remains as many children had no contact with the health system prior to death and those who sought formal care still died. Further efforts are needed to respond to urgent cases in communities and further understand remaining barriers to accessing appropriate, quality care.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Behavioral model of predictors of care-seeking behavior.
Fig 2
Fig 2. Study participants.
See this image and copyright information in PMC

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