Occurrence of major infectious diseases and healthcare seeking among young children with disabilities in Sierra Leone using cross-sectional population-based survey data

Abstract

Background: Children with disabilities are at risk of worse health outcomes compared to children without functional difficulties. Sierra Leone has one of the world's highest prevalences of functional difficulties among children, but little is known about the co-occurrence of major infectious diseases and healthcare-seeking behaviours among children with disabilities.

Methods: We used household survey cross-sectional data on children 2-4 years old and logistic regression models estimating ORs between functional difficulties and symptoms of infectious diseases including diarrhoea, fever and acute respiratory infection (ARI), adjusted for sex, age and stunting. We also examined whether caregivers sought advice or treatment for the illness from any source and if the child was given any treatment for the illness.

Results: There was an increased risk of fever among children with functional difficulty (adjusted OR (AOR)=1.3, 95% CI 1.1 to 1.8) and children with severe functional difficulty (AOR=1.6, 95% CI 1.0 to 2.7). Children with severe functional difficulty were also at increased risk of diarrhoea (AOR=1.8, 95% CI=1.1 to 3.3). There were no significant differences in seeking advice or treatment for diarrhoea, fever or ARI symptoms between the groups.

Conclusions: In Sierra Leone, children with functional difficulties, especially severe functional difficulties, more often have symptoms of major childhood diseases that are known to increase under-5 mortality.

Keywords: Epidemiology; Mortality; Neurology.

Figure 1

Identifying children with functional difficulties. The child functioning module asked the mother/caretaker a set of questions on eight areas of functioning regarding their child. Each area was assessed against a rating scale, with the answer categories ‘no difficulty’, ‘some difficulty’, ‘a lot of difficulty’ and ‘cannot do at all’. The child was considered having a functional difficulty at the response of ‘a lot of difficulty’ or ‘cannot do at all’, and severe functional difficulty at the response of ‘cannot do at all’. The only exception was the domain of controlling behaviour, where the response categories were instead ‘not at all’, ‘less’, ‘the same’, ‘more’ and ‘a lot more’ (not presented in the figure). The child was considered having a functional difficulty at the response of ‘a lot more’.

Figure 2

Identifying episodes of illness, healthcare seeking and access to treatment. In the survey’s care of illness module, the mother/caretaker was asked if the child had been ill with diarrhoea, fever or cough in the last 2 weeks. If the child had been ill with cough, the mother/caretaker was asked if the child had difficulty breathing during that illness. The child was considered having ARI symptoms if it had cough and difficulty breathing at the same time, meaning cough due to a chest problem. To identify healthcare-seeking behaviour, the mother/caretaker was asked if they had sought advice or treatment for the illnesses, respectively. To identify access to treatment, the mother/caretaker was asked if the child had been given medicine for the fever or cough. ARI, acute respiratory infection