An Examination of the Risk Factors and Care-seeking behavior for Childhood Diarrhoea and Childhood Pneumonia at the Primary level of care in Cross River State, Nigeria – A Mixed Methods Study

AIM. A critical examination of the care seeking behavior and the incidence of childhood diarrhoea and childhood pneumonia in children under five years in communities in Cross River State in order to measure the impact of interventions at the primary care level. METHODS. Mixed methods study in randomly selected communities across the State, where volunteer caregivers and care providers participated in Focus Group Discussions between November 2011 and January 2012, to share their perceptions of the illnesses and personal experiences in caring for children with diarrhoea and pneumonia. All caregivers in other randomly selected communities were interviewed by trained volunteers during the diarrhoea peak season, between January and March 2012, to collect information on factors associated with childhood diarrhoea and pneumonia, their knowledge of the illnesses, care seeking patterns and possible influencing factors of the care routes used at the primary level of care. Care routes used by caregivers were compared with the recommendations for childhood diarrhoea and pneumonia at the local level of care. A multivariate logistic regression estimated the associated risk factors for the episodes of illness in the two weeks preceding the study and the care choices used by the caregivers. RESULTS. Focus Group discussions with 35 participants showed that care for children with diarrhoea was often given at home as recommended but not with recommended rehydration therapy but more with herbal home therapies while care for pneumonia were sought at the health care facility because this illness is still poorly understood. A survey of 1270 caregivers in five local government areas showed that mothers aged 25 to 34 years (AORᵐᵃᵗᵉʳⁿᵃˡ ᵃᵍᵉ = 0.72 (95% CI 0.54 to 0.96)) and who had received at least primary education (AORᵐᵃᵗᵉʳⁿᵃˡ ᵉᵈᵘᶜᵃᵗᶦᵒⁿ ᵖʳᶦᵐᵃʳʸ = 0.54 (95% CI 0.32 to 0.93)) were protective for childhood diarrhoea and childhood pneumonia (AORᵐᵃᵗᵉʳⁿᵃˡ ᵃᵍᵉ = 0.14 (95% CI 0.44 to 0.45) and AORᵐᵃᵗᵉʳⁿᵃˡ ᵉᵈᵘᶜᵃᵗᶦᵒⁿ ᵖʳᶦᵐᵃʳʸ = 0.34 (95% CI 0.14 to 0.84) respectively) in the two weeks preceding the study. The area of residence and increasing maternal age were factors that encouraged the use of recommended care routes at home for diarrhoea and health facility treatment for pneumonia. CONCLUSION. The delivery and implementation of health education messages needs to be strengthened across the State for childhood diarrhoea and pneumonia.