Inequities among the very poor: health care for children in rural southern Tanzania
Inequities among the very poor: health care for children in rural southern Tanzania
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DOI：
10.1016/s0140-6736(03)12515-9
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发表时间：
2003-02-15
期刊：
影响因子：
168.9
通讯作者：
Bryce, J
中科院分区：
文献类型：
--
作者：
Schellenberg, JA;Victora, CG;Bryce, J
很少有研究评估非洲国家健康方面的社会经济不平等。我们寻求证据的性别和社会经济地位的幼儿生活在贫困的农村地区南部Tanzana.Methods在坦桑尼亚的基线家庭调查早期在实施阶段的儿童疾病综合管理（IMCI）的医疗保健不公平，我们包括2006年在4个农村地区的5岁以下的儿童的集群样本。问题的重点是护理人员对疾病的了解、在家庭外寻求护理以及在卫生设施中的护理在多大程度上符合儿童疾病综合管理的指导方针和信息。我们使用主成分分析开发家庭社会经济地位的相对指数，与收入来源，教育的户主，家庭资产的信息加权得分。结果1026（52%）的1968名儿童报告说，在2周前的调查生病。在1014名儿童中，415名（41%）的照顾者首先从适当的提供者那里寻求照顾。71名（26%）来自最富裕的五分之一家庭的护理人员知道大于或等于2个危险信号，而来自最贫穷家庭的护理人员知道大于或等于2个危险信号的护理人员为48名（20%）（五分之一之间的线性趋势为p=0.03），较富裕的家庭更有可能将患病儿童带到卫生机构（p=0.02）。他们的孩子更有可能比贫穷的儿童接受抗疟药，抗生素治疗肺炎（p=0.0001和0.0048，分别）。解释求医行为是更糟糕的贫困比在相对富裕的家庭，即使在农村社会，可能很容易被假定为统一贫穷。
Background Few studies have been done to assess socioeconomic inequities in health in African countries. We sought evidence of inequities in health care by sex and socioeconomic status for young children living in a poor rural area of southern Tanzania.Methods In a baseline household survey in Tanzania early in the implementation phase of integrated management of childhood illness (IMCI), we included cluster samples of 2006 children younger than 5 years in four rural districts. Questions focused on the extent to which carers' knowledge of illness, care-seeking outside the home, and care in health facilities were consistent with IMCI guidelines and messages. We used principal components analysis to develop a relative index of household socioeconomic status, with weighted scores of information on income sources, education of the household head, and household assets.Findings 1026 (52%) of 1968 children reported having been ill in the 2 weeks before the survey. Carers of 415 (41%) of 1014 of these children had sought care first from an appropriate provider. 71 (26%) carers from families in the wealthiest quintile knew greater than or equal to2 danger signs compared with 48 (20%) of those from the poorest (p=0.03 for linear trend across quintiles) and wealthier families were more likely to bring their sick children to a health facility (p=0.02). Their children were more likely than poorer children to have received antimalarials, and antibiotics for pneumonia (p=0.0001 and 0.0048, respectively).Interpretation Care-seeking behaviour is worse in poorer than in relatively rich families, even within a rural society that might easily be assumed to be uniformly poor.