Delay in seeking healthcare for pneumonia and associated factors among mothers/caregivers of children aged 2–59 months in public health facilities in Nekemte town, Ethiopia

In low- and middle-income nations, pneumonia is the primary infectious cause of mortality and morbidity [1]. In children aged less than 59 months, the burden of pneumonia remains high due to the younger age of the child associated with low immunity, pre-existing diseases, malnutrition, air pollution, missing vaccinations, and environmental hazards like (indoor air pollution, overcrowding, and smoking) [1‐3]. Although several microorganisms are the etiologic agents of pneumonia, Streptococcus pneumonia and H. influenzae are the most common bacteria that cause pneumonia [2]. The respiratory syncytial virus is the most common type of virus that causes pneumonia in younger children [3].

Complications of pneumonia are categorized either as local (parapneumonic effusion, empyema, necrotizing pneumonia, and lung abscess) or as systemic (bacteremia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation and, rarely, death) [4]. However, children from pneumonia can be protected (through effective use of exclusive breastfeeding and complementary feeding), prevented (by vaccination, hand washing with soap, reducing household air pollution, and preventing infectious diseases), and treated by the appropriate therapies, including supplemented oxygen [3].

Globally, almost 1 million children under the age of five die from pneumonia every year, accounting for 15% of all child deaths, while South Asia and sub-Saharan Africa are predominantly affected by this infectious disease [3]. Africa loses thousands of children due to pneumonia each year that causes around 750,000 child deaths per year in sub-Saharan African countries [3]. In Ethiopia, pneumonia kills 15 people per 1000 live births, and the country ranks sixth among the top 15 countries in the world for pneumonia morbidity and mortality [5].

Primary caregivers’ timely recognition of the signs and symptoms, as well as subsequent care seeking for treatment, are poor, resulting in many under-five deaths in developing countries despite effective treatment for pneumonia exists [6]. As a result, the World Health Organization (WHO) estimates that prompt medical attention can save 20% of children’s lives and dramatically reduce morbidity from acute respiratory infections, including pneumonia [7]. Delaying seeking healthcare for pneumonia contributes to many deaths in developing countries [8]. Around the world, 40% of kids put off getting the aid and care they need, but in sub-Saharan Africa, where pneumonia kills the most kids, that number rises to almost 60% [9]. In our country, Ethiopia, health-seeking behavior is deficient in around 61.3% of caregivers [10].

According to a WHO report, more than half of childhood mortality is caused by a delay or insufficient response to medical care, which can be avoided by obtaining medical help sooner [11]. Despite the fact that it is recommended that children seek immediate medical attention, approximately 40% of children worldwide do not receive the necessary aid and care, and approximately more than half of children in sub-Saharan Africa, where the majority of pneumonia deaths occur, are left at home or delay in seeking care [9].

According to a United Nations International Children Emergency Fund (UNICEF) report, just 3 out of every five children in Sub-Saharan Africa with pneumonia-specific symptoms are not early taken to an appropriate health facility for treatment; children from poorer and less educated families are less likely to seek care [12]. Accordingly, in Chad (27.4%), Central African Republic 30.9%, Democratic Republic of Congo (44.2%), Nigeria (41.9%), Sierra Leone (73.2%) and Malawi (68.8%) seek health care on time respectively whereas the remained delayed to seek care from the health facility for their children [9]. The Ethiopian Demographic Health Survey (EDHS) 2016 report showed that about 70% of mothers with less than 5 years old do not seek healthcare promptly without delay for pneumonia (acute respiratory infections) in Ethiopia [12].

According to earlier research [13, 14], mothers’ and caregivers’ health-seeking for pneumonia in children between the ages of 2-59 months is influenced by socio-demographic factors, such as parental socioeconomic status, health facility-related factors (such as distance from the health facility), and lack of awareness of pneumonia.

In agreement with the WHO, the Ethiopian government is implementing integrated community case management to reduce childhood-related mortality and morbidity due to pneumonia [15]. The Ethiopian government is working to improve the survival of children under five [16]. For example, training healthcare workers, formulating case management guidelines, strengthening communities with health insurance services and adequate health information, and extending healthcare facilities and infrastructures for implementing integrated community case management.

However, from our experience, caregivers’ practices like taking their baby to church, using traditional methods, and using types of syrup previously bought for unrelated cases are reported. A community uses different beliefs, cultures, and traditional ways of managing childhood illness. Some of them are toxic to child growth and development. The Ethiopian government’s commitment alone is not sufficient to reduce childhood mortality and morbidity due to pneumonia. There is limited research sought to identify the level and contributing factors related to delay in healthcare seeking for pneumonia in Ethiopia. Therefore, this study desired to assess the level of delay in healthcare seeking for pneumonia and associated factors among caregivers of U5C in public health facilities in Nekemte town, Ethiopia.

This cross-sectional study aimed to determine the level of delay in seeking healthcare for pneumonia and associated factors among caregivers of U5C in public health facilities in Nekemte, Ethiopia. In this study, the proportion of delay in seeking healthcare for pneumonia in children aged 2–59 months is 62.2%. This finding is higher than the study conducted in Bangladesh (58%) [22] and Rwanda (56%) [23]. However, it is less than the study conducted in the Peruvian Amazon (65%) [24], Tanzania (87.2%) [25] and Kenya (66.1%) [26]. The difference might be due to variations in information access about healthcare, the availability and quality of healthcare services and healthcare workers, and the distance at which a healthcare facility is found from their home.

According to this study, early healthcare seeking for pneumonia in children is more commonly practiced by urban than rural mothers/caregivers. This finding is similar to Kenya [27] and Ethiopia, Bahir Dar [17]. This is likely because urban residents have better access to adequate information about pneumonia or health facilities in their local communities than rural residents. This demonstrates that rural residents delay taking an ill child with pneumonia to the hospital for one of two reasons: poor or insufficient information about pneumonia or a lack of a nearby facility. Providing adequate information to the rural community about pneumonia in U5C is valuable.

Mothers/caregivers with lower monthly incomes also initiated efforts to obtain prompt healthcare when their children showed features of pneumonia. This finding is supported by the study conducted in Kenya [26] and Ensaro District [20]. This might be due to the absence of money for treating the ill child. Besides, mothers/caregivers probably move to nearby towns to search for their daily income, which could expose them to a lack of transportation as there is a conflict due to political issues. This has an impact on their ability to seek treatment for pneumonia as soon as possible. Strengthening communities’ opportunity to use healthcare insurance is essential.

The study showed that there is a higher delay in seeking healthcare for pneumonia among younger children (12–59 months) than among infants (≤11 months). This is in harmony with the findings in Bangladesh [28], sub-Saharan Africa [29], and Tanzania [30]. From our experience, mothers/caregivers give more of their caring activities and time to the younger baby in the study area. Another reason could be that mothers and caregivers believe children over 1 year can tolerate illness better than their younger counterparts. Additionally, community health insurance prevents exposure to delays in early healthcare for pneumonia. This is in line with research findings from Bahir Dar, Ethiopia [17]. And it shows that if caregivers/mothers do not doubt treatment costs, they promptly visit healthcare facilities to treat their children for pneumonia. Encouraging caregivers/mothers to utilize community health insurance is suggested.

Moreover, self-medication is another reason for delays in seeking early healthcare for pneumonia. The result of this study was in line with a study conducted in Uganda [31]. The reason for this could be a lack of community awareness of healthcare seeking and a decrease in health information dissemination by health workers. In contrast, the study conducted in Rwanda [23] revealed that the significant predictors of delay in seeking care remained among parents’ special prayers. This might be due to the high perception of the community on their religion and poor awareness of the community in healthcare-seeking pneumonia in children aged 2-59 months.

Furthermore, mothers’ and caregivers’ lack of knowledge about pneumonia causes significant delays in prompt healthcare seeking. This is supported by research from Pakistan [32], Kenya [26], and Bahir Dar, Ethiopia [17]. This could be due to inadequate information or education about pneumonia. Improving mothers’ and caregivers’ knowledge of pneumonia is critical in U5C. Besides that, mothers/caregivers who believe pneumonia is a minor illness delay seeking medical attention earlier than those who do not think, so pneumonia is a minor illness. This research was similar to that done in the Philippines [33], Yemen [34], and Rwanda [23]. The information they had about pneumonia, whether from someone else or from their previous child’s illness (lesson learned), may have assisted the mothers/caregivers in visiting healthcare facilities. According to the findings of this study, mothers and caregivers with a history of hospitalization for their children visit healthcare facilities earlier. It is in line with study findings in Rwanda [23]. The reason might be due to the adequate information she acquired from the healthcare workers and other caregivers or the lessons learned from the negative consequences of pneumonia. It indicates that healthcare is a better place for getting correct information about pneumonia in children. Therefore, delivering the proper education or appropriate information about pneumonia to the mother/caregivers of the hospitalized child should be encouraged.

In this study, the proportion of delay in seeking healthcare for pneumonia among children aged 2–59 months is high. Delay in seeking healthcare seeking was significantly and positively associated with rural residence, low monthly income, the age of the child (≥12 months), not using community health insurance, using self-medication at home, poor knowledge about pneumonia, a poor perception of the severity of the pneumonia illness, and previous admission status of a child. Creating caregivers’ awareness or providing adequate health education to develop early healthcare-seeking behavior at religious centers and through mass media and encouraging caregivers to use health insurance is essential.