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Cross Sectional Survey of Care Seeking For Acute Respiratory Illness in Children Under 5 Years in Rural Kenya
American Journal of Pediatrics
Volume 4, Issue 3, September 2018, Pages: 69-79
Received: Sep. 6, 2018; Accepted: Sep. 19, 2018; Published: Oct. 12, 2018
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Elizabeth Wanjiku Ndungu, Department of Community Health, Kenyatta University, Nairobi, Kenya
Florence Nafula Okwara, Department of Paediatrics and Child Health, Kenyatta University, Nairobi, Kenya
John Paul Oyore, Department of Community Health, Kenyatta University, Nairobi, Kenya
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Acute respiratory infection (ARI) is a leading cause of childhood morbidity and mortality in developing countries. In Kenya, diagnosis and treatment of ARI remains predominantly health facility based. This presumes that caretakers can recognize ARI symptoms promptly and make a decision to take the child to an appropriate health facility for treatment. Unfortunately, these presumptions have not been assessed. This study sought to establish determinants of health care seeking among caretakers of children under five years (CU5) of age with ARI. An analytic cross sectional survey was carried out in Githunguri Sub - County of Kiambu County. Households with CU5 who had recently suffered an episode of ARI were enrolled. Structured questionnaires, focused group discussions and key informant guides were used to gather information. Structured questionnaires were administered to caretakers to obtain information on socio-demographics, knowledge and health seeking practices. Bivariate and multivariate analysis was carried out with a p value of < 0.05. From 438 households sampled, 323 (73.7%) had CU5 in their households. Out of these, 240 (74.3%) of the children had an episode of ARI in the preceding 2 weeks. The mean age of the children was 29.2 months, with male to female ratio of 1:1. The mean mothers’ age was 29.4 years, 71.2% were married, 54.8% had secondary education and 66.6% were of Christian-protestants faith and (90.0%) were in informal employment. Poor knowledge of pneumonia was documented in 92.5% of caretakers. One hundred and forty nine (62.1%) caretakers had delayed health facility consultation for ARI. The main factors associated with delayed facility consultation were poor knowledge of symptoms (p = 0.007) long distance to the nearest health facility (p = 0.002), means of transport used to access the nearest health facility (p = 0.001) and previous high expenditure at health facility (p = 0.011). On logistic regression, the main factors that independently determined delayed facility consultation were long waiting time (>1hour) before service provision (p = 0.001), use of a motorbike to access the nearest health facility (p = 0.001) and traveling for 4 - 4.9 kilo meters to the nearest health facility (p = 0.002). Travelling for long distance and long waiting time before service provision during the previous facility visit were the main determinants of delayed facility consultations. The study recommends increased sensitization on symptom recognition among caretakers, and intensified efforts to reduce turn-around time during health facility consultations in order to minimize delays in health facility consultation.
Acute Respiratory Illness, Children Under Five Years, Health Facility Consultation
To cite this article
Elizabeth Wanjiku Ndungu, Florence Nafula Okwara, John Paul Oyore, Cross Sectional Survey of Care Seeking For Acute Respiratory Illness in Children Under 5 Years in Rural Kenya, American Journal of Pediatrics. Vol. 4, No. 3, 2018, pp. 69-79. doi: 10.11648/j.ajp.20180403.15
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WHO. World Health Organization Fact Dheet for Pneumonia - Google Search [Internet]. 2015 [cited 2016 Aug 16]. Available from:
Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008;86(5):408–416B.
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. The lancet. 2010;375(9730):1969–1987.
KDHS. Kenya Demographic Health Survey. 2014. kenya - Google Search [Internet]. 2014 [cited 2016 Aug 17]. Available from:
Bigogo GM, Breiman RF, Feikin DR, Audi AO, Aura B, Cosmas L, et al. Epidemiology of respiratory syncytial virus infection in rural and urban Kenya. J Infect Dis. 2013; 208 (suppl 3):S207–S216.
IHME. Pushing the Pace: Progress and Challenges in Fighting Childhood Pneumonia. Seattle - Google Search [Internet]. 2014 [cited 2016 Aug 16]. Available from:
GAPPD. Global Action Plan for Prevention and Control of Pneumonia and Diarrhea - Google Search [Internet]. 2014 [cited 2016 Aug 17]. Available from:
Young M, Wolfheim C, Marsh DR, Hammamy D. World Health Organization/United Nations Children’s Fund joint statement on integrated community case management: an equity-focused strategy to improve access to essential treatment services for children. Am J Trop Med Hyg. 2012; 87(5 Suppl):6–10.
GHO. Care seeking for pneumonia global health observatory - Google Search [Internet]. 2015 [cited 2016 Aug 16]. Available from:
Githunguri Sub – County Health Records. Githunguri Sub – County Health Records. 2015. Anecdotal reports compiled from health facilities in Githunguri Sub – County. Kiambu, Kenya; 2015.
Bbaale E. Determinants of diarrhoea and acute respiratory infection among under-fives in Uganda. Australas Med J. 2011;4(7):400–409.
Astale T, Chenault M. Help-Seeking Behavior for Children with Acute Respiratory Infection in Ethiopia: Results from 2011 Ethiopia Demographic and Health Survey. PloS One. 2015;10(11):e0142553.
Kumar SG, Majumdar A, Kumar V, Naik BN, Selvaraj K, Balajee K, et al. Prevalence of acute respiratory infection among under-five children in urban and rural areas of puducherry, India. J Nat Sci Biol Med. 2015;6(1):3.
Källander K, Hildenwall H, Waiswa P, Galiwango E, Peterson S, Pariyo G. Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study. Bull World Health Organ. 2008;86(5):332–338.
Demissie B, Zerihun BEH, Tafese Z, Gamo G, Tafese T, Kumie A, et al. Assessment of health care seeking behavior of caregivers for common childhood illnesses in Shashogo Woreda, Southern Ethiopia. Ethiop J Health Dev. 2014; 28 (Special Issue):36–43.
Memon KN, Shaikh K, Pandhiani BS, Usman G. How do Mothers Recognize & Treat Pneumonia in their Children at Home? A study in Union Council Jhudo, District Mirpurkhas. JLUMHS. 2013;12(03):208.
Doracaj D, Grabocka E, Hallkaj E, Vyshka G. Healthcare-seeking Practices for Common Childhood Illnesses in Northeastern Albania: A Community-based Household Survey. J Adv Med Pharm Sci [Internet]. 2015 [cited 2016 Aug 16]; Available from:
Malhotra N, Upadhyay RP. Why are there delays in seeking treatment for childhood diarrhoea in India? Acta Paediatr. 2013;102(9):e413–e418.
Noordam AC, Carvajal-Velez L, Sharkey AB, Young M, Cals JW. Care seeking behaviour for children with suspected pneumonia in countries in Sub-Saharan Africa with high pneumonia mortality. PloS One. 2015;10(2):e0117919.
Kresno S, Harrison GC, Sutrisna B, Reingold A. Acute respiratory illnesses in children under five years in Indramayu, west Java, Indonesia: a rapid ethnographic assessment. Med Anthropol. 2010;15(4):425–434.
Keter P, Mbakaya C, Gikunju J, Mutai J. Knowledge, Perceptions and Practices of Mothers in Relation to Childhood Pneumonia at Kapsabet District Hospital in Nandi County, Kenya. - Google Search [Internet]. 2015 [cited 2016 Aug 16]. Available from:
Rehman A, Shaikh BT, Ronis KA. Health care seeking patterns and out of pocket payments for children under five years of age living in Katchi Abadis (slums), in Islamabad, Pakistan. Int J Equity Health. 2014;13(1):1.
Webair HH, Bin-Gouth AS. Factors affecting health seeking behavior for common childhood illnesses in Yemen. Patient Prefer Adherence [Internet]. 2013 [cited 2016 Aug 16];7. Available from: http://search.ebscohost
Mebratie AD, Van de Poel E, Yilma Z, Abebaw D, Alemu G, Bedi AS. Healthcare-seeking behaviour in rural Ethiopia: evidence from clinical vignettes. BMJ Open. 2014; 4 (2): e004020.
Bedford J. Qualitative study to identify solutions to local barriers to care-seeking and treatment for diarrhoea malaria and pneumonia in select high burden countries. Report on findings from Nigeria. 2012 [cited 2016 Aug 16]; Available from:
Simiyu DE, Wafula EM, Nduati RW. Mothers’ knowledge, attitudes and practices regarding acute respiratory infections in children in Baringo District, Kenya. East Afr Med J. 2003;80(6):303–307.
Ekure EN, Esezobor CI, Balogun MR, Mukhtar-Yola M, Ojo OO, Emodi IJ, et al. Mothers and childhood pneumonia: what should the focus of public campaigns be? Niger J Paediatr. 2013;40(1):24–29.
Bedford, Sharkey AB. Local barriers and solutions to improve care-seeking for childhood pneumonia, diarrhoea and malaria in Kenya, Nigeria and Niger: a qualitative study. PloS One. 2014;9(6):e100038.
Sharkey A, Chopra M, Jackson D, Winch PJ, Minkovitz CS. Influences on healthcare-seeking during final illnesses of infants in under-resourced South African settings. J Health Popul Nutr. 2011;379–387.
Van der Hoeven M, Kruger A, Greeff M. Differences in health care seeking behaviour between rural and urban communities in South Africa. Int J Equity Health. 2012;11(1):1.
Najnin N, Bennett CM, Luby SP. Inequalities in Care-seeking for Febrile Illness of Under-five Children in Urban Dhaka, Bangladesh. J Health Popul Nutr [Internet]. 2011 Nov 13 [cited 2016 Aug 16];29(5). Available from:
Sakisaka K, Jimba M, Hanada K. Changing poor mothers’ care-seeking behaviors in response to childhood illness: findings from a cross-sectional study in Granada, Nicaragua. BMC Int Health Hum Rights. 2010;10(1):1.
Taffa N, Chepngeno G. Determinants of health care seeking for childhood illnesses in Nairobi slums. Trop Med Int Health. 2005;10(3):240–245.
Irimu G, Nduati RW, Wafula E, Lenja J. Community understanding of pneumonia in Kenya. Afr Health Sci [Internet]. 2008 [cited 2016 Aug 16];8(2). Available from:
Alvesson HM, Lindelow M, Khanthaphat B, Laflamme L. Shaping healthcare-seeking processes during fatal illness in resource-poor settings. A study in Lao PDR. BMC Health Serv Res. 2012;12(1):1.
Kim SA, Capeding MRZ, Kilgore PE. Factors influencing healthcare utilization among children with pneumonia in Muntinlupa City, Philippines. Southeast Asian J Trop Med Public Health. 2014;151:919.
Kosai H, Tamaki R, Saito M, Tohma K, Alday PP, Tan AG, et al. Incidence and Risk Factors of Childhood Pneumonia-Like Episodes in Biliran Island, Philippines—A Community-Based Study. PloS One. 2015;10(5):e0125009.
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