Visits were made to 2,810 households (97% of households in selected enumeration areas); a primary caretaker was available for interview in 2,360 (84%) households. Of the 2,360 households, 1,009 (43%) had at least one under-five child. Caretakers of 28 (2.8%) households refused to participate. In total, 1,679 under-five children were included from 981 households with an under-five child, and 4,544 persons aged over five years in these households were also included ().
Distribution of reported illness syndromes* among healthcare-use survey respondents, by age-category, Bondo district, Kenya, 2005
In the participating households, 85% of primary caretakers were female, and 44% had not completed primary school. Forty-one percent of the households were classified as of higher socioeconomic status; radios (79%), bicycles (63%), and furniture (54%) were the most common possessions. Most (86%) households relied on surface-water for drinking, and 59% used pit-latrines (the remainder had no toilet).
Of the 1,679 under-five children, 14% [95% confidence interval (CI) 12-16] had diarrhoea, and 44% (95% CI 41-46) had subjective fever in the past two weeks (). The median duration of episodes of diarrhoea was three days, and the median duration of fever was four days. Thirty-one percent (n=72) of children with diarrhoea and 26% (n=191) of children with fever met our criteria for severe illness episodes.
Episodes of respiratory illness were reported for 222 (13%) of the 1,679 under-five children, the majority (n=158; 71%) of whom had illness onset—cate-gorized as ARI—in the two weeks preceding the interview. Compared to ARI episodes, respiratory illness episodes that occurred more than two weeks in the past—categorized as pneumonia—were significantly more likely to have included wheezing (94% for pneumonia vs 79% for ARI; p=0.01), to have met our criteria for severe respiratory illness (40% vs 20%; p=0.01), to have been hospitalized (26% vs 7%; p< 0.01), and to have been diagnosed with pneumonia by a healthcare worker (86% vs 18%; p<0.01). ARI episodes also tended to have lower mortality (2%) than pneumonia episodes (8%; p=0.06).
All illness syndromes were reported less frequently among household members aged five years or older compared to under-five children ().
Of the under-five children, complete data on healthcare-seeking behaviour were available for 78% of respiratory illness episodes, 81% of diarrhoeal episodes, and 81% of febrile episodes (syndromes not mutually exclusive). Treatment at a health facility was sought in 35-42% of illnesses that occurred during the preceding two weeks (). Care was slightly more commonly sought at hospitals for ARI (18%, 95% CI 12-26) than for diarrhoea (8%, 95% CI 5-13) or fever (11%, 95% CI 9-14). Common sources of healthcare-seeking outside the household for ARI, diarrhoea, or fever were drug-sellers (range 39-45%) and private care providers (range 22-24%). A relatively few children visited traditional healers (range 3-7%) or village health volunteers (range 5-6%) ().
Healthcare-seeking behaviours of caretakers of under-five children, by reported illness, Bondo district, Kenya, 2005
For pneumonia episodes in the preceding 12 months (excluding ARI in the preceding two weeks), the caretakers reported seeking healthcare outside the home for all episodes. Significantly more of these episodes resulted in visits to health facilities (88%, 95% CI 76-95), visits to hospitals (48%, 95% CI 35-62), and hospitalizations (26%, 95% CI 16-40) than for ARI in the past two weeks (). Of the 13 children with reported pneumonia who were hospitalized, nine (69%) had first visited an outpatient health centre for care.
Diagnostic procedures were uncommonly reported for all syndromes. Of children with febrile illnesses, blood smears were reported for 17% of episodes. Chest radiographs for pneumonia and tests of stool specimens for diarrhoea episodes were performed in 6% and 2% of episodes respectively (). In contrast, intake of antibiotics and antimalarials was common. Of children with ARI, diarrhoea, or fever in the past two weeks, 61%, 62%, and 56% took an antibiotic and 59%, 52%, and 61% took an antimalarial drug respectively. Children with any of the reported illnesses often received herbal reme-dies (range 34-40%) or were prayed for with regard to their illness (range 26-40%) (Table 2).
Compared to under-five children, other household members aged five years or older had generally similar patterns of most healthcare-seeking behaviours (). However, persons aged over five years visi-ted health facilities less often than young children for episodes of pneumonia (66% vs 88%, p=0.01).
Healthcare-seeking behaviours of persons aged 5 years or older*, by reported illness, Bondo district, Kenya, 2005
shows the proportions of under-five res-pondents with syndromes of interest who visited health facilities, stratified by gender, age, socioeconomic status, educational level of caretakers, and severity of illness. In multivariate analyses, including all these factors simultaneously, household socioeconomic status and severity of illness were independently associated with seeking healthcare at health facilities (significant independent associations are denoted by single asterisks in ). For pneumonia episodes, children in households with higher socioeconomic status were more likely to be taken to any health facility [adjusted odds ratio (AOR)=21.8, 95% CI 1.0-456.9] or to be taken to a hospital (AOR=4.1, 95% CI 1.4-12.2) and be hospitalized (AOR=7.3, 95% CI 1.1-48.1). Children with more severe pneumonia were more likely to be taken to a hospital than children with less severe pneumonia (AOR=5.9, 95% CI 1.4-25.2). For diarrhoea episodes, higher socioeconomic status was associated with seeking healthcare at a hospital (AOR=3.4, 95% CI 1.0-10.8). For febrile episodes, more severe illness was associated with more hospitalizations (AOR=3.7, 95% CI 1.4-9.4). Healthcare was more often sought for male children, although the differences were not significant (). Of other household members aged five years or older, households with higher socioeconomic status were associated with a higher probability of visiting any health facility for febrile illness; greater severity of illness was associated with a higher probability of visiting any health facility for febrile illness and a higher probability of visiting a hospital for pneumonia (data not shown).