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Multilevel Analysis of Factors Associated with Treatment-Seeking Behaviors among Caregivers with Febrile Children in Malawi
Owen Nkoka
Owen Nkoka
School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan;
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Ting-Wu Chuang
Ting-Wu Chuang
Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Yi-Hua Chen
Yi-Hua Chen
School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan;
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Early diagnosis and treatment of childhood fever, an important sign of potentially serious infections such as malaria, is essential for controlling disease progression, and ultimately, preventing deaths. This study examined individual- and community-level factors associated with treatment-seeking behaviors and promptness in these behaviors among caregivers of febrile under-five children in Malawi. The 2015–2016 Malawi Demographic Health Survey was used to analyze a nationally representative sample of 4,133 under-five children who had fever within 2 weeks before the survey. A multilevel logistic regression model was used to examine the association between individual- and community-level factors and treatment-seeking behaviors. Approximately 67.3% of the caregivers reported seeking treatment for their febrile child, whereas only 46.3% reported promptly seeking treatment. Children from communities with moderate and high percentages of educated caregivers were more likely to be taken for treatment (adjusted odds ratio [aOR] = 1.26, 95% CI = 1.01–1.58 and aOR = 1.31, 95% CI = 1.02–1.70, respectively) than those from communities with a low percentage of educated caregivers. Children from communities with moderate and high percentages of caregivers complaining about the distance to a health facility were less likely to be taken for treatment (aOR = 0.74, 95% CI = 0.58–0.96 and aOR = 0.67, 95% CI = 0.51–0.88, respectively). At the individual level, having a cough in the last 2 weeks, region, religion, and having better health behaviors in other health dimensions were associated with fever treatment-seeking behaviors among Malawian caregivers. Programs aimed at improving treatment-seeking behaviors should consider these factors and the regional variations observed in this study.
Author Notes
Authors’ addresses: Owen Nkoka and Yi-Hua Chen, School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan, E-mails: onkoka@gmail.com and yichen@tmu.edu.tw. Ting-Wu Chuang, Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, E-mail: chtingwu@tmu.edu.tw.
Availability of Data and Materials: The study used, with permission, data from the International Classification of Functioning, Disability, and Health (ICF). The data are publicly available and may be requested from the ICF through https://dhsprogram.com/data/available-datasets.cfm.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
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1.
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2.
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4.
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-
26.
Adinan J, Damian DJ, Mosha NR, Mboya IB, Mamseri R, Msuya SE, 2017. Individual and contextual factors associated with appropriate healthcare seeking behavior among febrile children in Tanzania. PLoS One 12: e0175446.
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27.
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-
29.
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-
30.
Wiseman V, Scott A, Conteh L, McElroy B, Stevens W, 2008. Determinants of provider choice for malaria treatment: experiences from the Gambia. Soc Sci Med 67: 487–496.
-
31.
Ntenda PAM, Chuang KY, Tiruneh FN, Chuang YC, 2017. Analysis of the effects of individual and community level factors on childhood immunization in Malawi. Vaccine 35: 1907–1917.
-
32.
Nkoka O, Chuang T-W, Chuang K-Y, Chen Y-H, 2018. Factors associated with insecticide-treated net usage among women of childbearing age in Malawi: a multilevel analysis. Malar J 17: 372.
-
33.
Babalola S, Ricotta E, Awantang G, Lewicky N, Koenker H, Toso M, 2016. Correlates of intra-household ITN use in Liberia: a multilevel analysis of household survey data. PLoS One 11: e0158331.
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-
35.
Nkoka O, Chuang T-W, Chen Y-H, 2018. Association between timing and number of antenatal care visits on uptake of intermittent preventive treatment for malaria during pregnancy among Malawian women. Malar J 17: 211.
-
36.
Robson K, Pevalin D, 2016. Multilevel Modeling in Plain Language. London, United Kingdom: Sage Publications.
-
37.
Gupta M et al. 2003. International differences in in-hospital revascularization and outcomes following acute myocardial infarction: a multilevel analysis of patients in ASSENT-2. Eur Heart J 24: 1640–1650.
-
38.
Ntenda PAM, Chuang Y-C, 2018. Analysis of individual-level and community-level effects on childhood undernutrition in Malawi. Pediatr Neonatol 59: 380–389.
-
39.
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-
40.
Altman DG, Bland JM, 1994. Statistics notes: quartiles, quintiles, centiles, and other quantiles. BMJ 309: 996.
-
41.
O’brien RM, 2007. A caution regarding rules of thumb for variance inflation factors. Qual Quant 41: 673–690.
-
42.
Evans EA, Upchurch DM, Simpson T, Hamilton AB, Hoggatt KJ, 2017. Differences by veteran/civilian status and gender in associations between childhood adversity and alcohol and drug use disorders. Soc Psychiatry Psychiatr Epidemiol 53: 421–435.
-
43.
Masangwi SJ, Ferguson N, Grimason A, Morse T, Kazembe L, 2010. Care-seeking behaviour and implications for malaria control in southern Malawi. South Afr J Epidemiol Infect 25: 22–26.
-
44.
Kazembe LN, Appleton CC, Kleinschmidt I, 2007. Choice of treatment for fever at household level in Malawi: examining spatial patterns. Malar J 6: 40.
-
45.
Chinkhumba J, Skarbinski J, Chilima B, Campbell C, Ewing V, San Joaquin M, Sande J, Ali D, Mathanga D, 2010. Comparative field performance and adherence to test results of four malaria rapid diagnostic tests among febrile patients more than five years of age in Blantyre, Malawi. Malar J 9: 209.
-
46.
Mathanga DP, Walker ED, Wilson ML, Ali D, Taylor TE, Laufer MK, 2012. Malaria control in Malawi: current status and directions for the future. Acta Trop 121: 212–217.
-
47.
Ansari S, Soltero EG, Lorenzo E, Lee RE, 2017. The impact of religiosity on dietary habits and physical activity in minority women participating in the Health is Power (HIP) study. Prev Med Rep 5: 210–213.
-
48.
Chege PM, Kimiywe JO, Ndungu ZW, 2015. Influence of culture on dietary practices of children under five years among Maasai pastoralists in Kajiado, Kenya. Int J Behav Nutr Phys Act 12: 131.
-
49.
Tan KL, 2011. Factors associated with exclusive breastfeeding among infants under six months of age in peninsular Malaysia. Int Breastfeed J 6: 2.
-
50.
Kretchy I, Owusu-Daaku F, Danquah S, 2013. Spiritual and religious beliefs: do they matter in the medication adherence behaviour of hypertensive patients? Biopsychosoc Med 7: 15.
-
51.
Tegegne M, Sileshi S, Benti T, Teshome M, Woldie H, 2017. Factors associated with minimal meal frequency and dietary diversity practices among infants and young children in the predominantly agrarian society of Bale zone, southeast Ethiopia: a community based cross sectional study. Arch Public Health 75: 53.
-
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-
53.
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