Care-seeking for fatal illnesses in young children in Indramayu, west Java, Indonesia

Area of Science:

• Child Health
• Public Health
• Medical Anthropology

Background:

• Child mortality remains a significant global health challenge, particularly in low-income regions.
• Understanding care-seeking behaviors for critically ill children is crucial for improving health outcomes.
• Traditional healing practices often coexist with or precede Western medical interventions in many communities.

Purpose of the Study:

• To investigate patterns of care-seeking for critically ill children under five in Indramayu, West Java, Indonesia.
• To identify factors associated with seeking or not seeking Western medical care for severe childhood illnesses.
• To analyze the role of traditional healers in the care pathway for deceased children.

Main Methods:

• A population-based study was conducted in 10,000 households in Indramayu, West Java, Indonesia.
• Data were collected on all deaths in children under five between July 1, 1991, and December 31, 1992.
• Information on treatment sought, including traditional and Western medical care, was recorded for children who died from natural causes.

Main Results:

• A total of 141 deaths in children under five were identified, with a mortality rate of 80.7 per 1000 live births.
• Of the 139 deaths from natural causes, 22% received no outside treatment, and 42% consulted only traditional healers.
• Seeking Western medical care was significantly associated with child's age, illness duration, prior maternal participation in maternal-and-child-health programs, and maternal attitudes towards hypothetical severe pneumonia cases.

Conclusions:

• A substantial proportion of critically ill children in this Indonesian setting did not receive timely Western medical care.
• Care-seeking decisions were influenced by factors related to the child's condition and the mother's engagement with health services, not socioeconomic status or proximity to facilities.
• Interventions aimed at improving child survival should consider these complex care-seeking behaviors and potentially integrate traditional and Western medical approaches.