Determinants affecting utilisation of health services and treatment for children under-5 in rural Nepali health centres: a cross-sectional study.
Determinants affecting utilisation of health services and treatment for children under-5 in rural Nepali health centres: a cross-sectional study.
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DOI：
10.1186/s12889-022-14318-y
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发表时间：
2022-10-20
影响因子：
4.5
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中科院分区：
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--
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尼泊尔在儿童健康方面仍然存在很大的不平等现象，种姓、族裔和性别是造成贫困和负面后果的主要决定因素。本研究的目的是探讨5岁以下儿童的关键人口统计数据是否与寻求健康的行为，利用医疗保健和接受治疗有关。数据来自五个地区23个卫生中心的新生儿和儿童疾病综合管理记录。纸质记录数字化后，按地区、种姓/种族、性别和年龄对数据进行分析，以调查ARI、腹泻和发热症状发作后到卫生机构就诊所需时间的差异;肺炎诊断的准确性;以及是否根据IMNCI指南为肺炎开出了正确的治疗处方。从23个保健中心的116个登记簿中，有30 730份儿童病历被考虑进行分析。入学的中位年龄为18个月（四分位数间距= 10，32），而更多的男孩入学（55.7%对44.3%的女孩）。不同地区的儿童因急性呼吸道感染、腹泻和发烧到保健中心就诊的时间存在统计学显著差异，偏远的胡姆拉和穆古地区的儿童在出现症状后到保健设施就诊的时间明显更长（所有p < 0.001，穆古地区除外）。来自马德西人和达利特人等贫困族裔群体的儿童不太可能得到正确的肺炎诊断（p = 0.014），而男性比女性更有可能得到正确的诊断（73%对67%，p = 0.001）。这种性别差异在肺炎诊断的校正回归模型中仍然存在（p < 0.001），但在肺炎治疗中则没有（p = 0.628）。与廓尔喀相比，所有地区正确诊断和治疗肺炎的几率都有所增加，但调整后仅在Mugu的儿童中具有显著性（p ≤ 0.001）。在检查ARI、腹泻和发热的就医行为时，发现基于种族、性别和地区的人口统计学差异显著。当探索肺炎诊断的准确性时，这些相同的因素也有显著的相关性，但与治疗无关。这项研究强调了数字化医疗保健系统的重要性，在这个系统中，不平等现象可以在不依赖轶事证据的情况下被发现。在线版本包含补充材料，可在10.1186/s12889-022-14318-y获得。
Large inequalities in child health remain in Nepal, with caste, ethnicity and sex being major determinants of deprivation and negative outcomes. The purpose of this study was to explore whether key demographics of under 5s were associated with health seeking behaviours, utilisation of health care, and treatment received. Data came from Integrated Management of Neonatal & Childhood Illness (IMNCI) records of 23 health centres across five districts. After digitising the paper records, the data was analysed by district, caste/ethnicity, sex, and age to investigate differences in the time taken to present at a health facility after the onset of symptoms of ARI, diarrhoea and fever; accuracy of diagnosis for pneumonia; and whether the correct treatment was prescribed for pneumonia as per IMNCI guidelines. From 116 register books spanning 23 health centres, 30,730 child patient records were considered for analysis. The median age of attendance was 18 months (Inter-Quartile Range = 10, 32), while were more male children that attended (55.7% vs. 44.3% for females). There were statistically significant differences for the time taken to attend a health centre between different districts for ARI, diarrhoea and fever, with children in the remote Humla and Mugu districts taking significantly longer to present at a health facility after the onset of symptoms (all p < 0.001, except Mugu for ARI days). Children from underprivileged ethnic groups, Madhesi and Dalit, were less likely to be given a correct diagnosis of pneumonia (p = 0.014), while males were more likely to receive a correct diagnosis than females (73% vs. 67%, p = 0.001). This sex difference remained in the adjusted regression models for diagnosis of pneumonia (p < 0.001) but not for treatment of pneumonia (p = 0.628). All districts, in comparison to Gorkha, had increased odds of correct diagnosis and treatment of pneumonia, but only significant in children from Mugu after adjustment (p ≤ 0.001). Significant demographic differences were found based on ethnicity, sex, and district when examining health seeking behaviours for ARI, diarrhoea, and fever. Significant associations were seen for these same factors when exploring accuracy of diagnoses of pneumonia, but not for treatment. This study has emphasised the importance of a digitalised healthcare system, where inequalities can be identified without the reliance on anecdotal evidence. The online version contains supplementary material available at 10.1186/s12889-022-14318-y.
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影响因子：
2.3
作者：
Hodge, Andrew;Byrne, Abbey;Jimenez-Soto, Eliana
通讯作者：
Jimenez-Soto, Eliana
影响因子：
4.6
作者：
Fagbamigbe, A. F.;Kandala, N. B.;Uthman, A. O.
通讯作者：
Uthman, A. O.
影响因子：
3.2
作者：
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通讯作者：
Van Damme, Wim
影响因子：
4.8
作者：
Angdembe, Mirak Raj;Dulal, Bishnu Prasad;Karn, Sumit
通讯作者：
Karn, Sumit
影响因子：
3.7
作者：
Bhatta, Dharma Nand;Aryal, Umesh Raj
通讯作者：
Aryal, Umesh Raj