Characteristics of the children
About 4272 participated in the study, 2855 (67%) and (1417) 37% represented respondents in the 2015 and 2018 MIS respectively. In 2018 survey, there were more respondents ≥ 24 months old, 886 (57%) of the sample, while in 2015 survey, the proportions of respondents in the two age groups were approximately the same. The proportion of males and females in both surveys was almost similar, (females- 47.9% and 50.7%) 2015 and 2018 respectively.
A greater proportion of participants in 2015 were from rural areas 2315 (66%), contrary in 2018, where most respondents were from urban 1124 (54%) of the sample. The majority of the respondents belonged to the second wealthy quintiles as the highest only represented about 489 (17.1%) and 235 (16.6%) in the 2015 and 2018 MIS respectively. History of fever two weeks prior to the survey was less common in 2018 MIS 171 (12.1%) compared to 348 (48.9%) in 2015 among the respondents. Overall, of those that had fever, only 215 (7%) and 21 (12%) in 2015 and 2018 surveys respectively sought treatment within 24 hours of onset of fever (Table 1). The proportion of early health seeking behaviour among those who reported to have fever two weeks prior to the surveys was less in 2018 at 14 (5%) compared to 178 (79%) in 2015 (Fig. 1).
Table 1
Basic characteristics of participants’ under-5-years in the 2015 and 2018 MIS, Zambia
Year
|
2015
|
2018
|
Variables
|
Count (n)
|
*Weighted percentage*
|
Count (n)
|
*Weighted Percentage* (%)
|
Total 4272
|
2855
|
67.0
|
1417
|
37.0
|
Age group of the child
|
|
|
|
|
Less-than 24 months
|
1199
|
42.0
|
531
|
37.6
|
24 months and above
|
1656
|
58
|
886
|
62.5
|
Sex of the child
|
|
|
|
|
Female
|
1366
|
47.9
|
718
|
50.7
|
Male
|
1489
|
52.2
|
699
|
49.3
|
Wealth quintile
|
|
|
|
|
Lowest
|
596
|
17.0
|
311
|
12.0
|
Second
|
642
|
20.0
|
322
|
15.0
|
Middle
|
584
|
19.0
|
306
|
17.0
|
Fourth
|
544
|
21.0
|
243
|
19.0
|
Highest
|
489
|
23.0
|
235
|
36.0
|
Residence
|
|
|
|
|
Urban
|
957
|
33.5
|
767
|
54.1
|
Rural
|
1898
|
66.5
|
650
|
46.0
|
Relationship of the child to care-tacker
|
|
|
|
|
Son/Daughter
|
2194
|
77
|
1059
|
76
|
Other
|
|
23.0
|
|
26.0
|
Head of housed that had an education
|
|
Yes
|
2162
|
87.0
|
856
|
78.0
|
No
|
323
|
13.0
|
252
|
23.0
|
Education level of care-takers
|
|
|
|
|
primary
|
1405
|
57
|
620
|
56.5
|
Secondary
|
906
|
35.8
|
380
|
34.6
|
Tertiary
|
154
|
6.3
|
97
|
8.8
|
History of fever
|
Yes
|
348
|
48.9
|
171
|
21.0
|
No
|
1456
|
51.0
|
1119
|
79.0
|
*Weighting indicates that an observation in a survey represents a certain number of people a finite population* |
Characteristics of the care-givers
Respondents who were biological children to care-givers represented about 75.7% of respondents in both surveys, while the rest were any other relative. Respondents whose household heads had some education were 2466 (86.5%) and 1097 (77.5%) in 2015 and 2018 surveys respectively. Most of the care-givers in 2015 and 2018 MIS had a primary level of education and represented about 1405 (57%) and 620 (56.5%) respectively (Table 1).
Factors associated with health-seeking behaviour among febrile children under-5-years after on-set of fever in 2015 and 2018 MIS
Early health-seeking behaviour was less common among children 0-23 months (45.5%) in 2015 compared 64.3% among the same age group in 2018 survey. In 2018 there were more children 0-23 months old that sought treatment early compared to those 24-59 months old. While in the age group 24-59 months, there was a reduction in the proportion of health-seeking behaviour in 2018 (35.7%) compared to 54.5% in 2015 MIS.
More females (43%) than males (36%), in 2015MIS sought treatment within 24hrs of onset of fever p= 0.946. While in 2018, the proportion of early health-seeking between sex’ was not different, p=0.795. Comparing the two years the reduction in health-seeking behaviour for either sex in 2018 was not statistically significant. In 2015 MIS most participants that sought treatment early, (88.8%) were from rural areas compared to only (48.8%; p=0.100) in 2018 among the same communities. There was a reduction in early health seeking behaviour between the two years among the rural community.
In 2015, the proportion among respondents that sought treatment early was higher among all the quintile; (lower (17%), second (22%), middle (19%), fourth (14%) and higher (7%)) compared with the same quintiles in 2018 with p<0.05. However, there was no difference in health seeking behaviour among the quintiles in 2018, (p= 0.147). In 2015 most of the respondents that sought treatment early were children to care-givers (66.2% p= 0.405), compared with (22.8% p=0.100) in 2018 MIS among children who were any other relative to care-givers.
About 42% and 27% (p<0.05) household heads had primary and secondary level of education in 2015 respectively. In 2018, only 2.7% and 2.1% respectively (p= 0.8) sought treatment within 24 hours of onset of fever. Comparing the two surveys there were more children whose household head had some education who sought treatment within 24hrs of fever in 2015 (66.3% p =0.90). This was higher compared to (4.3%, p= 0.7) in 2018. This reduction in health seeking behaviour between the two years was not statistically significant (Table 2).
Table 2
Adjusted logistic: Chi Square, P-value= 0.05.
Health-seeking behaviour by:
|
Odds ratio
|
95% Confidence Interval
|
P-value
|
Odds ratio
|
95% Confidence interval
|
P-value
|
Age of a child
|
2015 MIS
|
2018 MIS
|
Less than 24 months
|
1.6
|
0.88
|
3.10
|
0.117
|
0.6
|
0.24
|
1.39
|
0.220
|
24 months and above
|
1
|
|
|
|
|
|
|
|
Sex of child
|
|
|
|
|
|
|
|
|
Female
|
1
|
|
|
|
|
|
|
|
Male
|
0.8
|
0.44
|
1.54
|
0.55
|
0.8
|
0.34
|
1.99
|
0.660
|
Education level of caretaker
|
|
|
|
|
|
|
|
|
Primary
|
1
|
|
|
|
|
|
|
|
Secondary
|
0.9
|
0.47
|
1.835
|
7.6
|
1.0
|
0.26
|
4.18
|
0.953
|
Higher
|
7.0
|
0.75
|
66.47
|
0.088
|
1
|
|
|
|
Residence
|
|
|
|
|
|
|
|
|
Urban
|
1
|
|
|
|
|
|
|
|
Rural
|
1.1
|
0.47
|
2.53
|
0.849
|
5.5
|
1.07
|
28.05
|
0.042
|
Wealth quintile
|
|
|
|
|
|
|
|
|
Lower
|
1
|
|
|
|
|
|
|
|
Second
|
1.8
|
0.84
|
0.97
|
0.131
|
0.9
|
0.30
|
2.69
|
0.850
|
Middle
|
3.1
|
1.26
|
7.56
|
0.014
|
0.6
|
0.19
|
1.91
|
0.038
|
Fourth
|
0.9
|
0.34
|
2.66
|
0.920
|
0.5
|
0.13
|
2.20
|
0.383
|
Highest
|
1.1
|
0.34
|
3.46
|
0.900
|
0.4
|
0.07
|
2.68
|
0.365
|
Relationship to child
|
|
|
|
|
|
|
|
|
parent
|
1
|
|
|
|
|
|
|
|
Other
|
0.8
|
0.30
|
3.20
|
0.970
|
1.2
|
0.24
|
6.20
|
0.804
|
Factors and health-seeking behaviour for febrile children under-5 years; a comparison of 2015 and 2018 MIS in Zambia
The multivariate analysis model contained all variables; age, sex, wealthy quintile, residence, relationship of care-giver with child, education status of care-givers and head of the household, as best predictors of health seeking behaviour. Although age, sex of the child, education level of care-giver and head of household were not statistically significant, they were maintained in the model owing to priori knowledge from other studies that showed that they are primary predictors of health-seeking behavior among febrile children suspected to have malaria (Table 2).
Health seeking behavior in 2015 was associated with wealth, while in 2018 it was associated with residence of the child Table 2.
Health seeking behavior in the 2015 MIS
In the multivariable analysis wealth quintile of the child was significantly associated with early health seeking behaviour among febrile children in the 2015 survey. Children in the middle wealth quintile compared to other wealth quintiles (AOR 3.1, 95% CI 1.26–7.56 p< 0.05 were 3 times more likely to seek treated early after onset of fever (Table 2).
While the study found association between other predictors of health seeking behaviour (age group, sex, residence, education level of care-givers, education status of head of household), this was not statistically significant. Children in the age group 0–23 months (AOR 1.6, 95%CI 0.88–3.10 p=0.12) were more likely to seek treatment early compared with those 24-59 months in the 2015. Secondly, there was no difference in health-seeking behaviour between male and female children (AOR 0.8 95%CI 0.44 - 1.54 p= 0.545), adjusting for other predictors of health-seeking behaviour (Table 2).
Furthermore, children whose care-givers had secondary education level were less likely to seek early treatment after onset of fever; compare with those with primary educational level; secondary (AOR 0.9 95%CI 0.47–1.84, p= 0.835). However, care-givers who had higher educational level were 7 times more likely to seek prompt treatment; (AOR 7.0 95%CI 0.75–66. 47, p=0.88). Additionally, there was no difference in early health-seeking behaviour after onset of fever between children in rural areas (AOR 1.1 95%CI 0.47-2.53 p= 0.849) compared with those in urban areas. Early health seeking behaviour among children whose care-givers were any other relative compared with children to care-givers (AOR 0.82 95% CI 0.4–1.8 p=0.6) were less likely to seek treatment within 24 hours of onset of fever (Table 2).
Children in the middle were 3 times more likely to seek treatment early after onset of fever compared with other quintiles (AOR 3.1 95% CI 1.26 – 7.56, p<0.05). While second, fourth and highest wealth quintile (AOR 1.8 95% CI 0.84 – 3.970.131), (AOR 1.0 95% CI 0.34–2.66 p-=0.920) and (AOR 1.1 95% CI 0.34–3.47 p=0.90) was not statistically significant respectively (Table2).
Health-seeking behaviour among febrile children under-5-years in the 2018 MIS
The study revealed important findings on the association between different factors for early health-seeking behaviour among febrile children in 2018 MIS. Health seeking behaviour was significantly associated with residence of the child. Children in rural areas were 5 times more likely to seek prompt treatment after on-set of fever (AOR 5.5 95% CI 1.06 - 1.13 p=0.042) compared with those in urban areas (Table 2).
In 2018 surveys, the study did not statistical significance among other factors of health seeking behaviour besides finding association (Age, Sex group of the child, Wealthy status, Education level of care-givers, Relationship of child to care-giver, Education of the head of the household). Children’s health-seeking behaviour among age group 0-23months of fever (AOR 0.6 95%CI 0.24–1.39 p=0. 220) compared with children 24-59 months old, was not different at adjusted logistic regression (Table 2). Male children were less likely to seek prompt treatment after onset of fever (AOR 0.8 95% CI 0.34–1.99 p=0.660). Care-givers with secondary education compared with those with primary education level were more likely to seek treatment early (AOR 1.0 95% CI 0.26–4.18, p=0.953) after onset of fever (Table 2).
Comparing children in the second, middle, fourth and higher quintile with those in the lowest quintile, were less likely to seek treatment early after onset of fever (AOR 0.9 95% CI 0.30–2.69 p= 0.845), (AOR 0.6 95% CI 0.20–1.91 p=0.383), (AOR 0.5 95% CI 0.13–2.20, p= 0.379) and (AOR 0.4 95% CI 0.07–2.68 p= 0.365) but this was not significant statistically. Children to care-givers were more likely to seek treatment within 24 hours of onset of fever (AOR 1.2 95% CI 0.24 – 6.20 P= 0.365) (Table 2).