Understanding the context of healthcare utilisation for children under-five with diarrhoea in the DRC: based on
Siyu Zou1,2, Xinran Qi3, Keiko Marshall4
1Vanke School of Public Health, Tsinghua University, Beijing, 100191, China.
Insights
Diarrhoea is a major child killer in the DRC. This study found that health needs, enabling resources, and caregiver education significantly impact healthcare-seeking behaviors for childhood diarrhoea treatment.
Area of Science:
- Global Health
- Pediatrics
- Health Services Research
Background:
- Diarrhoea remains a leading cause of mortality in children under five in the Democratic Republic of the Congo (DRC).
- Limited research exists on healthcare-seeking behaviors for childhood diarrhoea, particularly within the DRC context.
- The Andersen Behavioural Model was employed to investigate factors influencing healthcare utilization for diarrhoea treatment.
Purpose of the Study:
- To investigate and predict factors associated with healthcare-seeking behaviors for diarrhoea treatment in children under five in the DRC.
- To test the applicability of the Andersen Behavioural Model in the DRC.
- To identify key determinants of healthcare utilization for childhood diarrhoea.
Main Methods:
- Utilized data from 2626 under-five children with diarrhoea from the 2017-2018 Multiple Indicators Cluster Survey in the DRC.
- Employed structural equation modeling to analyze direct and indirect relationships among predisposing traits, enabling resources, health needs, and health services use.
- Modified the Confirmatory Factor Analysis model to better fit the DRC context.
Main Results:
- The modified Andersen Behavioural Model demonstrated good fit indices (GFI=0.972, CFI=0.953, RMSEA=0.043).
- Health needs (diarrhoea) showed the strongest positive direct effect on healthcare utilization (β=0.135, P<0.001), followed by enabling resources (β=0.051, P=0.015).
- Health needs mediated the positive effect of predisposing factors on utilization (indirect effect, β=0.014, P=0.009).
Conclusions:
- Improved water, sanitation, and household wealth significantly correlate with health-seeking behaviors for diarrhoea.
- Higher caregiver educational attainment is associated with increased positive health service utilization.
- Enhanced promotion and education on oral rehydration therapy (ORT) for caregivers are crucial.
Background:
Diarrhoea is one of the leading causes of death among children under 5 years old in the Democratic Republic of the Congo (DRC). Despite positive effects on prognosis, there is limited literature about the healthcare-seeking behaviours of children with diarrhoea, especially in the DRC. This study used the Andersen Behavioural Model, a theoretical framework, which was commonly adopted to study healthcare utilisation, to investigate and predict factors associated with the use of healthcare to treat diarrhoea in the DRC.
Methods:
Data collected from 2626 under-five children with diarrhoea in the last 2 weeks from the Multiple Indicators Cluster Survey conducted by the National Institute of Statistics in 2017-2018, in collaboration with the United Nations Children's Fund were used in this study. Both direct and indirect relationships among four latent variables: predisposing traits, enabling resources access, health needs, and health services use were measured using the structural equation modelling to test the Andersen behavioural model. The confirmatory Factor Analysis model was also modified based on the DRC context to explore this further.
Results:
The modified model had the goodness of fit index (GFI) of 0.972, comparative fit index (CFI) of 0.953 and RMSEA of 0.043 (95% CI: 0. 040, 0.047). Health needs (especially diarrhoea) had the largest positive direct effect on healthcare utilisation (standardized regression coefficient [β] = 0.135, P < 0.001), followed by "enabling resources" (β = 0.051, P = 0.015). Health needs also emerged as a mediator for the positive effect of predisposing on utilisation (indirect effect, β = 0.014; P = 0.009).
Conclusion:
Access to improved water and improved sanitation, as well as socioeconomic factors like household wealth, were significantly associated with health-seeking behaviours for diarrhoea treatment in the DRC. Besides, caregivers who own higher levels of educational attainments were more inclined to have positive health services uses during the treatments. Efforts are needed to enhance the oral rehydration therapy coupled with educating caregivers on its appropriate use.
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