Related Experiment Video
Updated: Jan 21, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Exploring the association between sick child healthcare utilisation and health facility quality in Malawi: a
Lingrui Liu1,2, Hannah H Leslie3, Martias Joshua4
1Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.
Insights
Improving healthcare quality in Malawi is crucial for increasing child healthcare utilization. Better facility quality, including structural readiness and process of care, is associated with higher service use, potentially reducing child mortality.
Area of Science:
- Global Health
- Pediatric Healthcare
- Health Services Research
Background:
- Basic healthcare availability is insufficient for achieving child survival goals in low- and middle-income countries.
- Healthcare utilization and quality of care remain significant challenges in high-mortality settings.
- This study investigates the link between healthcare quality and utilization for sick children in Malawi.
Purpose of the Study:
- To assess the association between poor quality of sick child healthcare and low utilization of these services in Malawi.
- To determine if facility structural readiness and process of care influence healthcare-seeking behavior for childhood illnesses.
- To inform strategies for improving child survival rates through enhanced healthcare services.
Main Methods:
- Utilized data from the 2013 Malawi Service Provision Assessment for facility quality metrics (structural readiness, process of care).
- Linked household data from the 2013-2014 Malawi Multiple Indicator Cluster Survey with facility geocodes.
- Employed logistic regression to analyze the association between facility quality and healthcare utilization for children under five with common illnesses, controlling for covariates. Sensitivity analyses were conducted.
Main Results:
- Malawian facilities demonstrated significant gaps in structural quality (62% readiness) and process quality (33%), averaging 48% overall quality.
- Higher facility quality was significantly associated with increased odds of utilizing sick child healthcare services (aOR: 1.66).
- Structural quality alone also showed a positive association with healthcare utilization (aOR: 1.33).
Conclusions:
- Despite widespread availability, the quality and utilization of curative child healthcare services in Malawi are suboptimal.
- Enhancing the quality of healthcare facilities may serve as a key strategy to boost service utilization.
- Improving healthcare quality holds the potential to decrease preventable childhood morbidity and mortality.
Objective:
Increasing the availability of basic healthcare services in low-and middle-income countries is not sufficient to meet the Sustainable Development Goal target for child survival in high-mortality settings, where healthcare utilisation is often inconsistent and quality of care can be poor. We assessed whether poor quality of sick child healthcare in Malawi is associated with low utilisation of sick child healthcare.
Design:
We measured two elements of quality of sick child healthcare: facility structural readiness and process of care using data from the 2013 Malawi Service Provision Assessment. Overall quality was defined as the average of these metrics. We extracted demographic data from the 2013-2014 Malawi Multiple Indicator Cluster Survey and linked households to nearby facilities using geocodes. We used logistic regression to examine the association of facility quality with utilisation of formal health services for children under 5 years of age suffering diarrhoea, fever or cough/acute respiratory illness, controlling for demographic and socioeconomic characteristics. We conducted sensitivity analyses (SAs), modifying the travel distance and population-facility matching criteria.
Setting And Population:
568 facilities were linked with 9701 children with recent illness symptoms in Malawi, of whom 69% had been brought to a health facility.
Results:
Overall, facilities showed gaps in structural quality (62% readiness) and major deficiencies in process quality (33%), for an overall quality score of 48%. Better facility quality was associated with higher odds of utilisation of sick child healthcare services (adjusted ORs (AOR): 1.66, 95% CI: 1.04 to 2.63), as was structural quality alone (AOR: 1.33, 95% CI: 0.95 to 1.87). SAs supported the main finding.
Conclusion:
Although Malawi's health facilities for curative child care are widely available, quality and utilisation of sick child healthcare services are in short supply. Improving facility quality may provide a way to encourage higher utilisation of healthcare, thereby decreasing preventable childhood morbidity and mortality.
More Related Videos
Related Concept Videos
01:50Cross-Sectional Research
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:26Profile Leveling and Cross Sections
01:16Spinal Cord: Cross-sectional Anatomy
Gray Matter and its Components
Central to the gray matter is...
01:11Genome-wide Association Studies-GWAS
GWAS does not require the identification of the target gene involved in...
01:17Healthcare Agencies II
Parish nursing is a growing specialty nursing profession that focuses on holistic healthcare, health promotion, and illness prevention. It blends professional nursing practice with a health ministry, focusing on health and healing within the context of a Christian community. Parish nurses serve as health educators, referral sources,...