Determinants affecting utilisation of health services and treatment for children under-5 in rural Nepali health centres: a cross-sectional study

Abstract

Background Large inequalities in child health remain in Nepal, with caste, ethnicity and sex being major determinants of deprivation and negative outcomes. The purpose of this study was to explore whether key demographics of under 5s were associated with health seeking behaviours, utilisation of health care, and treatment received. Methods Data came from Integrated Management of Neonatal & Childhood Illness (IMNCI) records of 23 health centres across five districts. After digitising the paper records, the data was analysed by district, caste/ethnicity, sex, and age to investigate differences in the time taken to present at a health facility after the onset of symptoms of ARI, diarrhoea and fever; accuracy of diagnosis for pneumonia; and whether the correct treatment was prescribed for pneumonia as per IMNCI guidelines. Results From 116 register books spanning 23 health centres, 30,730 child patient records were considered for analysis. The median age of attendance was 18 months (Inter-Quartile Range = 10, 32), while were more male children that attended (55.7% vs. 44.3% for females). There were statistically significant differences for the time taken to attend a health centre between different districts for ARI, diarrhoea and fever, with children in the remote Humla and Mugu districts taking significantly longer to present at a health facility after the onset of symptoms (all p  Conclusion Significant demographic differences were found based on ethnicity, sex, and district when examining health seeking behaviours for ARI, diarrhoea, and fever. Significant associations were seen for these same factors when exploring accuracy of diagnoses of pneumonia, but not for treatment. This study has emphasised the importance of a digitalised healthcare system, where inequalities can be identified without the reliance on anecdotal evidence.

Publication DOI: https://doi.org/10.1186/s12889-022-14318-y
Divisions: College of Health & Life Sciences > School of Optometry > Optometry
College of Health & Life Sciences
Additional Information: Copyright © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Publication ISSN: 1471-2458
Last Modified: 16 May 2024 07:19
Date Deposited: 02 Mar 2023 14:27
Full Text Link:
Related URLs: https://bmcpubl ... 889-022-14318-y (Publisher URL)
PURE Output Type: Article
Published Date: 2022-10-20
Accepted Date: 2022-10-04
Authors: Shrestha, Binod
Green, Dan J. (ORCID Profile 0000-0003-1934-6725)
Baidya, Manish
Chater, Tim
Karki, Jiban
Lee, Andrew CK
Khadka, Seema
Pohl, Gerda
Neupane, Rudra
Rushton, Simon

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