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Original Articles
Open Access

Understanding where parents take their sick children and why it matters: a multi-country analysis

Stephen Hodgins, Thomas Pullum and Leanne Dougherty
Global Health: Science and Practice November 2013, 1(3):328-356; https://doi.org/10.9745/GHSP-D-13-00023
Stephen Hodgins
aSave the Children, Washington, DC, USA
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  • For correspondence: shodgins@savechildren.org
Thomas Pullum
bICF International, Calverton, MD, USA
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Leanne Dougherty
cJohn Snow, Inc., Washington, DC, USA
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    Figure.

    Sources of Care Seeking for Childhood Illness

    1. 42 countries are included in the map.

    2. For purposes of characterizing the pattern of care seeking, public hospital, public outpatient health facility, and community health worker (CHW) are grouped to form “public.” Similarly, “private clinic” (which includes private hospital, private clinic, and private clinician) is grouped with retail sources, referred to here as “shop,” to form the category “private.”

    3. Comparing the proportion seeking care between two categories, if the difference is greater than 40 percentage points, the care-seeking pattern is characterized as simply “public” or “private” (more specifically “private clinic” or “shop” if that specific source is predominant).

    4. If the difference is from 10–40 percentage points, the adjective “mainly” is used.

    5. If the difference is less than 10, the term “mixed” is used.

    6. Additional sources of care are mentioned if a percent threshold is met, notably: at least 5% for non-allopathic, CHW, or NGO; and at least 10% for “shop” or “private clinic.”

    7. For the following countries, MICS data were used and covered only acute respiratory infection (ARI), not diarrhea or fever: Burundi, Central African Republic, Côte d'Ivoire, Guinea-Bissau, Kyrgyzstan, Laos, Mauritania, Mozambique, Somalia, Tajikistan, Togo, and Vietnam.

Tables

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    • View popup
    Table 1. Sources of Care for Acute Respiratory Infection (%)
    Public HospitalPublic Periph HFPrivate Clinic(ian)CHWNGO/ ReligiousPharmacy/ Shop OnlyNon-AllopathicOtherAny Public (not incl. CHWs)Any SourceNa
    Survey – DHS Africa
    West and Central Africa
    Benin 2006Urban(4)1911(4)1912102273453
    Rural(2)246(1)31412102666926
    All3227(1)316121025691,379
    DR Congo 2007Urban(8)1618(4)23(2)(1)2465226
    Rural(4)24510126(2)2656336
    All521107164(2)2660562
    Ghana 2008Urban(36)(3)(15)(10)(3)(38)6353
    Rural(14)32(4)(15)(1)(2)456697
    All2222(8)(13)(1)(2)4365150
    Guinea 2005Urban(13)40(7)(6)(2)(6)517295
    Rural(3)28(2)(5)1714(1)3165356
    All(5)30(3)(4)1512(2)3567451
    Liberia 2007Urban(15)43(16)(10)(1)5883104
    Rural(8)341815(4)(4)4278336
    All10361814(3)(3)4680440
    Mali 2006Urban(5)39(6)(1)(12)(6)(4)4369188
    Rural(1)32(1)(2)11103256518
    All(2)33(2)(1)51083559706
    Niger 2006Urban(5)42(7)(10)(16)(3)44679173
    Rural(1)242125425721,034
    All(2)26(1)19234(1)28731,207
    Nigeria 2008Urban18(6)(9)42(3)2477172
    Rural9138(2)36(2)2266519
    All11129(1)37(2)2269690
    Senegal 2010–2011Urban14379(2)(8)(1)5069310
    Rural(3)32(1)(2)(4)(6)(4)3550278
    All935(5)(2)(6)(3)(2)4360589
    Sierra Leone 2008Urban(8)(29)(11)(2)(9)(36)5856
    Rural(6)33(7)(2)(4)(1)(1)3851281
    All(6)32(7)(2)(5)(1)(1)3852337
    Southern Africa
    Lesotho 2009Urban(24)(9)(27)(22)(10)(32)(71)22
    Rural(8)32(7)(4)16(5)(2)3972162
    All(10)29(9)(4)17(5)(3)3972184
    Madagascar 2008–2009Urban(8)(18)(35)(1)(25)6152
    Rural3010(7)(2)(1)3047292
    All(1)2814(6)(2)(1)2949345
    Malawi 2010Urban3421(11)(3)5468168
    Rural14428116(1)(1)55781,053
    All17399106(1)(1)55761,221
    Namibia 2006–2007Urban(29)(34)(22)(4)(1)638752
    Rural2237(9)(1)5867149
    All243613(1)(1)5972201
    Swaziland 2006–2007Urban1231(6)(3)34(4)428232
    Rural(3)(50)(5)(1)(14)(6)(53)(77)182
    All(5)47(5)(2)17(6)5278214
    Zambia 2007Urban(10)57(1)(10)667295
    Rural(5)54(1)(1)(8)(5)(3)(1)5975209
    All(7)55(1)(1)(6)(6)(3)(1)6174304
    Zimbabwe 2010–2011Urban(3)34(6)16386038
    Rural(1)43(5)(4)(2)(44)(54)179
    All(2)42(1)(4)(6)(1)4355217
    East Africa
    Ethiopia 2011Urban(6)(15)(28)(2)(3)(19)5069
    Rural19522027703
    All(1)19722029773
    Kenya 2008–2009Urban(20)30(12)(10)(14)477971
    Rural12339(2)14(1)(1)4469346
    All133310(3)14(1)(1)4570416
    Rwanda 2010Urban(45)(21)(10)(6)(2)(45)8454
    Rural3514(3)(1)93558269
    All36(4)13(4)(1)83662322
    Tanzania 2010Urban(25)47(10)(14)708585
    Rural(6)5118(5)5778247
    All11501686080332
    Uganda 2011Urban(13)(16)55(3)(7)(3)2890141
    Rural42948(2)(1)3(1)(1)3282977
    All527492(1)4(1)(1)32831,118
    Survey – DHS Asia
    Bangladesh 2011Urban(5)(7)57(1)(1)(21)(3)(1)(12)9140
    Rural(3)(9)45(1)22(6)(1)1280237
    All(4)(8)47(1)(1)22(5)(1)1282277
    Cambodia 2010Urban(17)(24)(26)(22)(9)(39)8941
    Rural(5)212018242684457
    All621211823b2785498
    India 2005–2006Urban12460(1)33116811,110
    Rural61046144215704,762
    All7949144215725,872
    Indonesia 2007Urban(3)22295(1)23192594686
    Rural(2)231116(2)24(2)1925911,103
    All3221812(1)2421925921,789
    Nepal 2011Urban(28)(5)(43)(1)(26)(33)(89)24
    Rural(2)2019(3)31(2)(3)2277215
    All(5)1923(2)30(2)(2)2378238
    Pakistan 2006–2007Urban8(1)71(1)(1)(3)(6)989323
    Rural8(2)56(3)(2)121081854
    All8260(2)31010831,178
    Philippines 2008Urban(13)28(18)(2)(5)(1)3961127
    Rural(5)3013(4)15(1)3560197
    All82915(3)11(1)3660324
    Survey - MICS
    Burundi 2006Urban(17)(14)(15)(2)(6)(1)(2)31(52)25
    Rural6284(1)(1)333431,061
    All6274(1)(1)333431,086
    Central Afr Rep 2006Urban1912(7)(4)(1)112948283
    Rural(4)17(5)(4)(3)(3)(4)2036389
    All10156(2)(3)(2)7c2441672
    Côte d'Ivoire 2006Urban24(19)(13)(2)(5)(12)(7)4371121
    Rural(6)16(2)(3)(6)13172257301
    All1117(5)(3)61314c2861422
    Gambia 2006Urban(12)43(11)(19)(2)5479127
    Rural(8)56(7)(4)(7)(2)(2)6479236
    All10518(2)11(1)(2)6079362
    Guinea Bissau 2006Urban4526(11)(3)(1)(1)(9)6376101
    Rural1727(2)(5)(1)(1)(8)4153148
    All2827(5)(4)(1)(1)(8)4962249
    Kyrgyzstan 2006Urban42(27)(1)(6)697073
    Rural(17)48(8)(1)(1)575899
    All2839(4)(1)(3)6263172
    Laos 2006Urban(32)(8)(18)(15)(40)(73)18
    Rural(9)(13)(11)(9)(6)(3)2047172
    All(11)(13)(12)(9)(7)(3)2250190
    Mauritania 2007Urban1623(8)0(9)3853264
    Rural922(3)(3)(2)3136288
    All12225(2)53445552
    Mozambique 2008Urban(9)59(6)(2)(5)6677178
    Rural63(4)(1)(5)6373356
    All(3)62(4)(1)56474534
    Somalia 2006Urban(4)101128(1)1351280
    Rural(1)(2)(4)(2)14(1)(1)(3)22558
    All(2)46(1)18(1)(1)632838
    Tajikistan 2005Urban(30)(28)(58)(58)21
    Rural(23)(41)(13)(57)6743
    All(25)(37)(9)576464
    Togo 2006Urban(5)(12)(6)(1)(1)(7)(18)3034
    Rural(2)15(2)(2)(1)(7)(2)1730236
    All(3)14(3)(1)(1)(5)(4)1730270
    Vietnam 2006Urban36(13)45(6)(15)4999101
    Rural183526(6)8(1)(3)5089366
    All21312969(1)(2)5090467
    • ↵a N values are adjusted (see Methods section). Note that point estimates for proportions based on adjusted Ns of less than 25 are indicated in parentheses, indicating a lower level of precision.

    • ↵b This consisted mostly of “home of trained health worker.”

    • ↵c In most of these cases, the reported source was “parent or friend.”

    • Abbreviations: CHW, community health worker; HF, health facility; NGO, nongovernmental organization.

    • View popup
    Table 2. Sources of Care for Fever (%)
    Public HospitalPublic Periph HFPrivate Clinic(ian)CHWNGO/ ReligiousPharmacy/ Shop OnlyNon-AllopathicOtherAny Public (not incl. CHWs)Any SourceNa
    Survey – DHS Africa
    West and Central Africa
    Benin 2006Urban(6)201241791025731,307
    Rural2246(1)31210926632,854
    All3238(1)314101026664,162
    DR Congo 2007Urban61421(4)18(1)(4)1963950
    Rural(3)21610104(2)24541,519
    All418128133322572,469
    Ghana 2008Urban34(8)18234282197
    Rural1625(4)15(4)4164347
    All2319918(3)4170544
    Guinea 2005Urban1432(7)(2)17(4)(4)4373376
    Rural(1)24(2)(4)1911(1)26591,526
    All426341810(2)29621,902
    Liberia 2007Urban17302317(2)(2)4681450
    Rural62621159732741,127
    All92722157636761,577
    Mali 2006Urban(4)37(4)(1)1212(4)4172558
    Rural2524121126531,680
    All228(1)2612929572,238
    Niger 2006Urban(6)43(7)(9)13(1)(3)4978324
    Rural251818325622,019
    All(1)27(1)16172(1)28642,343
    Nigeria 2008Urban191012(1)33(1)2874987
    Rural9168(1)34(1)(1)25682,981
    All121491341126703,968
    Senegal 2010–2011Urban12307(2)9(1)442621,211
    Rural331(1)253234461,252
    All8314272338542,463
    Sierra Leone 2008Urban(11)1718(3)(16)(5)2869352
    Rural(4)308(2)6(1)3349931
    All62611(2)9(1)(2)32551,283
    Southern Africa
    Lesotho 2009Urban31(11)(8)(7)(5)(2)4360112
    Rural(6)269(6)16(4)(2)(1)3268465
    All11239(5)14(4)(2)3466577
    Madagascar 2008–2009Urban(5)1839(2)2463164
    Rural(1)2985(2)(1)3045952
    All(2)27134(1)(1)29471,116
    Malawi 2010Urban302413(5)(3)(1)5372786
    Rural11405108(1)(1)50735,428
    All1338698(1)51736,214
    Namibia 2006–2007Urban152517(5)(1)4063320
    Rural1536(5)(2)(1)5057476
    All153210(3)(1)4660795
    Swaziland 2006–2007Urban(7)(30)(9)(2)(12)(6)366198
    Rural(3)42(4)(1)10(5)(1)4563605
    All(4)40(4)(1)10(5)(1)4463703
    Zambia 2007Urban954(2)(7)6371276
    Rural(3)50(2)77(2)(2)5371768
    All551(1)(2)57(1)(1)55711,044
    Zimbabwe 2010–2011Urban(1)25(3)(1)12(3)2544134
    Rural(1)33(1)(4)(4)(1)3444372
    All(1)31(2)(3)6(1)3244506
    East Africa
    Ethiopia 2011Urban(4)1916(1)(4)2241226
    Rural(1)166(1)2(1)16241,659
    All(1)167(1)217261,885
    Kenya 2008–2009Urban2418(9)(4)114163223
    Rural10298(2)1439621,079
    All12278(2)1439621,302
    Rwanda 2010Urban(1)29(13)(14)(8)(1)3165172
    Rural26163(1)426491,183
    All262163(1)427511,355
    Tanzania 2010Urban1932(2)15165080454
    Rural(2)5223453781,300
    All74721753791,754
    Uganda 2011Urban21(11)45(3)(4)3285330
    Rural5244554(1)28832,712
    All6234554(1)28833,042
    Survey – DHS Asia
    Bangladesh 2011Urban(3)(8)45(1)20(3)(1)(11)7670
    Rural(2)(7)4321(5)(1)874318
    All(2)74321(4)(1)975388
    Cambodia 2010Urban(13)(13)2630(11)2586318
    Rural52717192131821,877
    All625182019b30822,194
    India 2005–2006Urban92462211601,954
    Rural4736(1)42211526,931
    All5638(1)32211548,885
    Indonesia 2007Urban(3)25256(1)211927931,937
    Rural2241115(1)2321925903,096
    All2241612(1)23219c26915,033
    Nepal 2011Urban(13)(6)(36)(1)(1)(27)(1)(19)8191
    Rural(2)1522(2)30(1)1771869
    All(3)1423(2)30(1)1772960
    Pakistan 2006–2007Urban8(1)67(1)(2)(4)(4)883791
    Rural9(2)51(4)(2)1411801,777
    All8(2)56331110812,569
    Philippines 2008Urban(6)2418(2)(6)3053586
    Rural(3)2210(4)102546799
    All52313(3)827491,385
    • ↵a N values are adjusted (see Methods section). Note that point estimates for proportions based on adjusted Ns of less than 25 are indicated in parentheses, indicating a lower level of precision.

    • ↵b This consisted mostly of home of trained health worker.

    • ↵c This consisted mostly of community nurse-midwives.

    • Abbreviations: CHW, community health worker; HF, health facility; NGO, nongovernmental organization.

    • View popup
    Table 3. Sources of Care for Diarrhea (%)
    Public HospitalPublic Periph HFPrivate Clinic(ian)CHWNGO/ ReligiousPharmacy/ Shop OnlyNon-AllopathicOtherAny Public (not incl. CHWs)Any SourceNa
    Survey – DHS Africa
    West and Central Africa
    Benin 2006Urban212621271539393
    Rural1152211101641925
    All2143211916401,317
    DR Congo 2007Urban(2)22(1)84(2)2434239
    Rural(1)2214522238360
    All(1)2212422337599
    Ghana 2008Urban22(8)(8)28(4)2966181
    Rural1722(4)19(2)3962361
    All1817522(2)3663542
    Guinea 2005Urban831(6)(1)87(2)3855200
    Rural(1)17412921844697
    All320(1)311922347897
    Liberia 2007Urban11291524(3)(5)3977293
    Rural422231816102679721
    All624202012930781,014
    Mali 2006Urban(3)255(2)8(2)2842325
    Rural14(1)38414281,334
    All(1)16238316311,660
    Niger 2006Urban(4)22(7)(8)(3)(2)2643242
    Rural14(1)123214321,576
    All(1)152113216331,818
    Nigeria 2008Urban171112(1)28(1)2870608
    Rural81362312222631,922
    All101372302223642,530
    Senegal 2010–2011Urban10214(1)7353148978
    Rural330(1)(1)45532471,268
    All6262(1)54532482,246
    Sierra Leone 2008Urban(5)2416(3)10(1)(2)2961153
    Rural5355344(2)4054523
    All532835323755676
    Southern Africa
    Lesotho 2009Urban24(6)(20)(3)(4)(6)295978
    Rural6257612(1)(4)(2)3159297
    All10219510(1)(3)(3)3159375
    Madagascar 2008–2009Urban(2)2624(4)(5)2857151
    Rural256(2)(2)(2)2638841
    All259(2)(2)32641993
    Malawi 2010Urban2525(3)45(1)(3)5063467
    Rural9435972252732,691
    All12404872251713,158
    Namibia 2006–2007Urban22398(3)(1)5767243
    Rural1739(3)(1)(4)(1)5463334
    All19395(2)(3)(1)5565577
    Swaziland 2006–2007Urban(11)(24)(11)(2)(22)(9)(2)357352
    Rural(4)505(1)16(2)(2)(1)5376292
    All5466(1)17(3)(2)(1)5075343
    Zambia 2007Urban(7)47(3)(3)5460291
    Rural(2)51(1)(2)537(2)5268619
    All3502243525365911
    Zimbabwe 2010–2011Urban(1)35(2)(1)(3)3540230
    Rural(1)29(1)(4)(1)(2)(2)3039458
    All(1)31(1)(1)(3)(1)(1)(2)3240688
    East Africa
    Ethiopia 2011Urban(2)3423(1)(5)3558158
    Rural226(1)2123331,326
    All248(1)3124361,483
    Kenya 2008–2009Urban181513(3)123259169
    Rural8337(1)(2)85(1)4060740
    All10298(1)294(1)3960909
    Rwanda 2010Urban(1)24(5)(6)(8)(4)(3)2548140
    Rural24(1)144382450992
    All2421343724501,132
    Tanzania 2010Urban1030(2)14113963276
    Rural2441644664833
    All44115644641,109
    Uganda 2011Urban(11)(14)47(2)(4)2574237
    Rural42841(1)3(1)(1)32771,528
    All52642(1)3(1)(1)31771,766
    Survey – DHS Asia
    Bangladesh 2011Urban(7)(8)45(1)(15)(1)(15)7570
    Rural(2)84024(4)1076318
    All(3)841(1)22(3)1176388
    Cambodia 2010Urban131445122102778131
    Rural52440162028741,029
    All622411619b28751,161
    India 2005–2006Urban1346132(1)16801,338
    Rural61044162316684,465
    All7948152316715,802
    Indonesia 2007Urban(1)1821419171977799
    Rural21981211721720721,381
    All119139118217c20742,180
    Nepal 2011Urban(11)(4)29(1)(26)(15)6965
    Rural2201332312261646
    All3181532312162711
    Pakistan 2006–2007Urban764(2)7(2)878325
    Rural7245(1)3310969732
    All72513488721,058
    Philippines 2008Urban521127(1)2545266
    Rural41910(1)6(2)2338294
    All42011622441560
    • ↵a N values are adjusted (see Methods section). Note that point estimates for proportions based on adjusted Ns of less than 25 are indicated in parentheses, indicating a lower level of precision.

    • ↵b This consisted mostly of “home of trained health worker.”

    • ↵c This consisted mostly of community nurse-midwives.

    • Abbreviations: CHW, community health worker; HF, health facility; NGO, nongovernmental organization.

    • View popup
    Table 4. Quality of ARI Care by “Received Antibiotics” (%)
    Survey“Appropriate” provider“Non-appropriate” provider
    Sought care (A)Received antibioticSought care (B)Received antibiotic
    (as a % of A)(as a % of B)
    Africa
    Ethiopia201127702(60)
    Ghana2008513514(16)
    Rwanda2010507412(28)
    Senegal2010–2011505010(26)
    Swaziland2010732150
    Uganda201179545(49)
    Zimbabwe2010–20114847751
    Asia
    Bangladesh201135834779
    Nepal201148372961
    • Values in parentheses are based on cell sizes of less than 25.

    • View popup
    Table 5. Quality of Diarrhea Care by “Appropriate” vs. “Non-Appropriate” Provider (%)
    Survey“Appropriate” Provider“Non-Appropriate” Provider
    Pills/syrups for non-bloody diarrheaORSPills/syrups for non-bloody diarrheaORS
    West and Central Africa
    Benin2006-63-14
    DR Congo2007-48-43
    Ghana200856705436
    Guinea2005-68-11
    Liberia200734732146
    Mali2006-50-4
    Niger2006-53-5
    Nigeria200862515720
    Senegal2010–201168475816
    Sierra Leone200875847859
    Southern Africa
    Lesotho20096275(44)(10)
    Madagascar2008–20097343618
    Malawi201049834461
    Namibia2006–20073687(39)(35)
    Swaziland2006–20076194(70)58
    Zimbabwe2010–20114945(69)(11)
    Zambia200750866726
    East Africa
    Ethiopia2011506252(26)
    Kenya2008–200954875072
    Rwanda2010626457(12)
    Tanzania201066646745
    Uganda201165545829
    Asia
    Bangladesh2011-87-77
    Cambodia201062507327
    India2005–200665366715
    Indonesia200774568026
    Nepal201148636642
    Pakistan2006–200765566137
    Philippines20084576(37)(54)
    • Values in parentheses are based on cell sizes of less than 25.

    • “-” is indicated for surveys for which a general question on types of treatment received for diarrhea was not asked.

    • Abbreviations: ORS, oral rehydration solution.

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Global Health: Science and Practice: 1 (3)
Global Health: Science and Practice
Vol. 1, No. 3
November 01, 2013
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Understanding where parents take their sick children and why it matters: a multi-country analysis
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Understanding where parents take their sick children and why it matters: a multi-country analysis
Stephen Hodgins, Thomas Pullum, Leanne Dougherty
Global Health: Science and Practice Nov 2013, 1 (3) 328-356; DOI: 10.9745/GHSP-D-13-00023

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Understanding where parents take their sick children and why it matters: a multi-country analysis
Stephen Hodgins, Thomas Pullum, Leanne Dougherty
Global Health: Science and Practice Nov 2013, 1 (3) 328-356; DOI: 10.9745/GHSP-D-13-00023
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