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Determinants and patterns of care-seeking for childhood illness in rural Pune District, India.

印度浦那区农村儿童疾病寻求护理的决定因素和模式。

  • 影响因子:3.08
  • DOI:10.7189/jogh.10.010601
  • 作者列表:"Marsh A","Hirve S","Lele P","Chavan U","Bhattacharjee T","Nair H","Juvekar S","Campbell H
  • 发表时间:2020-06-01
Abstract

Background:An estimated 1.2 million children under five years of age die each year in India, with pneumonia and diarrhea among the leading causes. Increasing care-seeking is important to reduce mortality and morbidity from these causes. This paper explores the determinants and patterns of care-seeking for childhood illness in rural Pune district, India. Methods:Mothers having at least one child <5 years from the study area of the Vadu Health and Demographic Surveillance System were enrolled in a prospective cohort study. Household sociodemographic information was collected through a baseline questionnaire administered at enrollment. Participants were visited up to six times between July 2015 and February 2016 to collect information on recent childhood acute illness and associated care-seeking behavior. Multivariate logistic regression explored the associations between care-seeking and child, participant, and household characteristics. Results:We enrolled 743 mothers with 1066 eligible children, completing 2585 follow-up interviews (90% completion). Overall acute illness prevalence in children was 26% with care sought from a health facility during 71% of episodes. Multivariable logistic regression showed care-seeking was associated with the number of reported symptoms (Odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.5-3.9) and household insurance coverage (OR = 2.2, 95% CI = 1.1-4.3). We observed an interaction between the associations of illness severity and maternal employment on care-seeking. Somewhat-to-very severe illness was associated with increased care-seeking among both employed (OR = 5.0, 95% CI = 2.2-11.1) and currently unemployed mothers (OR = 7.0, 95% CI = 3.9-12.6). Maternal employment was associated with reduced care-seeking for non-severe illness (OR = 0.3, 95% CI = 0.1-0.7), but not associated with care-seeking for somewhat-to-very severe illness. Child sex was not associated with care-seeking. Conclusions:This study demonstrates the importance of illness characteristics in determining facility-based care-seeking while also suggesting that maternal employment resulted in decreased care-seeking among non-severe illness episodes. The nature of the association between maternal employment and care-seeking is unclear and should be explored through additional studies. Similarly, the absence of male bias in care-seeking should be examined to assess for potential bias at other stages in the management of childhood illness.

摘要

背景: 印度每年估计有 120万名 5 岁以下儿童死亡,肺炎和腹泻是主要原因。增加护理寻求对于降低这些原因的死亡率和发病率是重要的。本文探讨了印度浦那区农村儿童疾病护理的决定因素和模式。 方法: 从Vadu健康和人口统计监测系统的研究区域中至少有一个孩子 <5 年的母亲被纳入一项前瞻性队列研究。通过入组时给予的基线问卷收集家庭社会人口学信息.在 2015 年 7 月至 2016 年 2 月期间,参与者被访问了多达六次,以收集关于近期儿童急性疾病和相关寻求护理行为的信息。多变量逻辑回归探讨了寻求照顾与儿童,参与者和家庭特征之间的关联。 结果: 我们招募了 743 名母亲和 1066 名符合条件的儿童,完成了 2585 次随访访谈 (90% 完成)。在 26% 的发作期间,在医疗机构寻求护理的情况下,儿童的总体急性病患病率为 71%。多变量logistic回归分析显示,寻求护理与报告的症状数量相关 (比值比 (OR)  = 2.4,95% 可信区间 (CI)  = 1.5-3.9) 和家庭保险 (or = 2.2,95% ci = 1.1-4.3)。我们观察到疾病严重程度与孕产妇就业之间的相互作用。某种程度到非常严重的疾病与两名就业者寻求护理的增加有关 (or =   5.0,95% ci =   2.2-11.1) 和目前失业的母亲 (or   =   7.0,95% ci   =   3.9-12.6)。孕产妇就业与非严重疾病寻求护理的减少相关 (or = 0.3,95% ci = 0.1-0.7),但与寻求某种程度至非常严重疾病的护理无关。儿童性行为与寻求护理无关。 结论: 本研究证明了疾病特征在确定基于机构的护理寻求中的重要性,同时也表明孕产妇就业导致非严重疾病发作中护理寻求减少。孕产妇就业和寻求护理之间联系的性质尚不清楚,应通过更多的研究进行探索。同样,应该检查在寻求护理中没有男性偏见,以评估在儿童疾病管理的其他阶段的潜在偏见。

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影响因子:2.81
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影响因子:2.89
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DOI:10.1016/j.ijid.2020.01.038
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肺炎方向

肺炎是指终末气道、肺泡和肺间质的炎症。可由细菌、病毒、真菌、寄生虫等致病微生物,以及放射线、吸入性异物等理化因素引起。临床主要症状为发热、咳嗽、咳痰、痰中带血,可伴胸痛或呼吸困难等。

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