BACKGROUND There is considerable evidence that health systems, in so far as they ensure access to healthcare, promote population health even independent of other determinants. Access to child health services remains integral to improving child health outcomes. Cognisant that improvements in child health have been unevenly distributed, it is imperative that health services and research focus on the disadvantaged groups. Children residing in urban slums are known to face a health disadvantage that is masked by the common view of an urban health advantage. Granted increasing urbanisation rates and proliferation of urban slums resulting from urban poverty, the health of under-five children in slums remains a public health imperative in Malawi. We explored determinants of healthcare-seeking from a biomedical health provider for childhood symptoms of fever, cough with fast breathing and diarrhoea in three urban slums of Lilongwe, Malawi. METHODS This was a population-based cross-sectional study involving 543 caregivers of under-five children. Data on childhood morbidity and healthcare seeking in three months period were collected using face-to-face interviews guided by a validated questionnaire. Data were entered in CS-Pro 5.0 and analysed in SPSS version 20 using descriptive statistics and logistic regression analyses. RESULTS 61% of caregivers sought healthcare albeit 53% of them sought healthcare late. Public health facilities constituted the most frequently used health providers. Healthcare was more likely to be sought: for younger than older under-five children (AOR = 0.54; 95% CI: 0.30-0.99); when illness was perceived to be severe (AOR = 2.40; 95% CI: 1.34-4.30); when the presenting symptom was fever (AOR = 1.77; 95% CI: 1.10-2.86). Home management of childhood illness was negatively associated with care-seeking (AOR = 0.54; 95% CI: 0.36-0.81) and timely care-seeking (AOR = 0.44; 95% CI: 0.2-0.74). Caregivers with good knowledge of child danger signs were less likely to seek care timely (AOR = 0.57; 95% CI: 0.33-0.99). CONCLUSIONS Even in the context of geographical proximity to healthcare services, caregivers in urban slums may not seek healthcare or when they do so the majority may not undertake timely healthcare care seeking. Factors related to the child, the type of illness, and the caregiver are central to the healthcare decision making dynamics. Improving access to under-five child health services therefore requires considering multiple factors.

中文翻译：

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马拉维城市贫民窟五岁以下儿童的照顾者寻求儿童疾病医疗保健的决定因素：一项基于人群的横断面研究。


背景 有大量证据表明，卫生系统只要确保获得医疗保健，就可以促进人口健康，甚至独立于其他决定因素。获得儿童健康服务仍然是改善儿童健康结果的组成部分。认识到儿童健康改善的分布不均，卫生服务和研究必须重点关注弱势群体。众所周知，居住在城市贫民窟的儿童面临健康劣势，但城市健康优势的普遍观点掩盖了这一劣势。鉴于城市化率不断提高以及城市贫困导致城市贫民窟激增，贫民窟中五岁以下儿童的健康仍然是马拉维公共卫生的当务之急。我们在马拉维利隆圭的三个城市贫民窟中，探讨了向生物医学保健提供者寻求医疗保健的决定因素，这些症状包括发烧、咳嗽、呼吸急促和腹泻等儿童症状。方法 这是一项基于人群的横断面研究，涉及 543 名五岁以下儿童的照顾者。通过在经过验证的调查问卷的指导下进行面对面访谈，收集了三个月内有关儿童发病率和医疗保健寻求的数据。数据输入 CS-Pro 5.0 中，并在 SPSS 20 版中使用描述性统计和逻辑回归分析进行分析。结果 61% 的护理人员寻求医疗保健，尽管其中 53% 的人寻求医疗保健较晚。公共卫生设施是最常用的医疗服务提供者。寻求医疗保健的可能性更大：五岁以下儿童比年龄大的儿童（AOR = 0.54；95% CI：0.30-0.99）；当疾病被认为很严重时（AOR = 2.40；95% CI：1.34-4.30）；当症状为发烧时（AOR = 1.77；95% CI：1.10-2.86）。 儿童疾病的家庭管理与寻求护理（AOR = 0.54；95% CI：0.36-0.81）和及时寻求护理（AOR = 0.44；95% CI：0.2-0.74）呈负相关。对儿童危险迹象有充分了解的护理人员及时寻求护理的可能性较小（AOR = 0.57；95% CI：0.33-0.99）。结论 即使在地理上靠近医疗保健服务的情况下，城市贫民窟的护理人员也可能不会寻求医疗保健，或者即使他们这样做，大多数人也可能不会及时寻求医疗保健。与孩子、疾病类型和护理人员相关的因素是医疗保健决策动态的核心。因此，改善五岁以下儿童健康服务的可及性需要考虑多种因素。