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. 2019 May 14;19(1):308.
doi: 10.1186/s12913-019-4142-x.

Household relationships and healthcare seeking behaviour for common childhood illnesses in sub-Saharan Africa: a cross-national mixed effects analysis

Joshua O Akinyemi  1   2 , Pamela Banda  3 , Nicole De Wet  3 , Adenike E Akosile  3   4 , Clifford O Odimegwu  3
Affiliations

Household relationships and healthcare seeking behaviour for common childhood illnesses in sub-Saharan Africa: a cross-national mixed effects analysis

Joshua O Akinyemi et al. BMC Health Serv Res. .

Abstract

Background: Intra-household dynamics play crucial roles in utilisation of healthcare services for children. We investigated the influence of household relationships on healthcare seeking behaviour for common childhood illnesses in four sub-Sahara African regions.

Methods: Data on 247,061 under-five children were extracted from recent Demographic and Health Surveys conducted between 2012 and 2016 in 25 countries. Data were combined and analysed per sub-region. Dependent variables (DVs) were uptake of health facility care for diarrhea and Acute Respiratory Tract Infection (ARI) symptoms. The main independent variable (IV) was household relationship which was represented by maternal marital profile (marital status, family type and number of marriages) and maternal relationship to household head. Mixed effects logit models were fitted to assess independent relationship between the IVs and DVs with adjustment for relevant demographic and socio-economic characteristics at 5% significance level.

Results: The percentage of children who received care for diarrhea and ARI symptoms from health facilities across sub-regions was: Western Africa (WA) 42.4, 44.1%; Central Africa (CA) 32.6, 33.9%; Eastern Africa (EA) 41.5, 48.7% and Southern Africa (SA) 58.9, 62.7%. Maternal marital profile was not associated with healthcare seeking behaviour for diarrhea and ARI symptoms in any of the sub-regions. Children whose mothers were daughter/daughter-in-law to household head were significantly less likely to be taken to health facility for diarrhea treatment in Eastern Africa (AOR = 0.81, CI: 0.51-0.95). Having a mother who is the head of household was significantly associated with higher odds of facility care for ARI symptoms for children from Western (AOR = 1.20, CI: 1.02-1.43) and Southern Africa (AOR = 1.49, CI: 1.20-1.85).

Conclusion: The type of relationship between mother of under-fives and head of households affect health seeking behaviour for treatment of diarrhea and ARI symptoms in Eastern, Western and Southern Africa. Countries in these regions need to adapt best practices for promoting healthcare utilisation for children such that household relationship does not constitute barriers.

Keywords: Childhood illnesses; Family context; Healthcare seeking behaviour; Healthcare utilisation; Household relationships; Sub-Saharan Africa.

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Conflict of interest statement

Ethics approval and consent to participate

No ethical approval was needed because anonymised secondary data archived by the DHS program was analysed. Prior to data collection in respective countries, the DHS program and country partners sought ethical approval from relevant authorities. DHS questionnaires and protocols are reviewed by the ICF Institutional Review Board [47] to ensure compliance with the U.S. Department of Health and Human Services regulations for the protection of human subjects (45 CFR 46). In addition, informed consent was taken before respondents were interviewed. No identifying information was collected during fieldwork; neither did the processed data contain items of information that could compromise privacy and confidentiality of survey participants. Formal approval to analyse the data was granted by the DHS program.

Consent for publication

Not applicable

Competing interests

Authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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