Type of Document	Thesis
Author	Lips, Cornelia Beatrice
Author's Email Address	ConnyLips@compuserve.com
URN	etd-03292007-030534
Title	Factors Affecting Decisions To Seek Treatment For Sick Children In A Rural Setting In The Middle East
Degree	Master of Science
Department	Nursing, School of
Advisory Committee	Advisor Name Title Linda Sullivan Committee Chair James Whyte Committee Member Mary Beth Zeni Committee Member Susan Porterfield Committee Member
Keywords	Diarrhea Malnutrition Rural Setting Yemen Mother’s Education Gender Care Decider Socioeconomic Status Health Care Provider Distance To Health Care Facility Illness Severity Under-5 Mortality Rate Sick Children Health Seeking Behaviour Nursing Cornelia Lips Parents/Caregivers Middle East Acute Respiratory Infections
Date of Defense	2007-03-19
Availability	unrestricted
Abstract Children in developing countries continue to die from diseases that are preventable or curable. These do not necessarily lead to death in the developed world. The literature reveals that every year ten to almost eleven million children die before they are five years old. Seven out of those ten childhood deaths are attributed to five main causes: pneumonia, diarrhea, measles, malaria, and malnutrition. Although there has been a decline in the under-5 mortality rate, the numbers are not dropping fast enough and this is particularly true for developing countries. The purpose of this study was to measure the effects of demographic variables, severity of illness, child’s gender and age, mother’s education, on the decisions of parents’/caregivers’ in Lahaj, the Republic of Yemen, to seek treatment for their sick children. The choice of health care provider as well as accessibility of health care facilities was evaluated. The conceptual framework that guided this research was the Health Belief Model and Blum’s Model. A case-control analysis was done using data collected in the summer 2005 from the governorate of Lahaj in the Republic of Yemen. A survey of a non-probability sample of households was obtained by trained interviewers with an 87 item questionnaire. One hundred and seventy five children were eligible for this study because they had at least one of the following symptoms: fever (84%), cough (67.4%), and diarrhea (41.7%) 2 weeks prior to the interview. Of these 175 children, 57% were boys and 43% were girls. Children with moderate or severe illness for whom no treatment was sought were designated cases. Those children with moderate or severe illness for whom treatment was sought were designated controls. Bivariate analysis was used to describe the relationship between potential predictor variables and parents’/caregivers’ choices to seek treatment or not to seek treatment. Logistic regression was used to derive odds ratios. The analysis showed that children with moderate illness were significantly more likely not to receive care than children with severe illness. The results showed that male children were significantly more likely not to receive care than female children. Furthermore, the results showed that children who lived 31 or more minutes away from a health facility were more than 4 ½ times as likely not to receive care as children who lived within 10 minutes of a health care facility. When asked for reasons of not seeking care, parents’/caregivers’ response was that treatment was not considered necessary, followed by cost, other or distance to health facility. Environmental characteristics showed that only 33% of households had water piped inside their dwelling; the remaining households who didn’t, spend an average time of 39 minutes obtaining water. Once water was obtained, the majority of households (94%) reported doing nothing to purify their drinking water. Sanitation systems in rural areas were poor and only 6% of households had toilet facilities connected to a sewer. The remaining households used either open air (43%), or a toilet connected to an open air drainage (14%), or not connected to a sewer (37%). In conclusion, disease severity, gender, and distance to health care facility predicted whether children with moderate or severe illnesses were taken to a health care facility. The inquiry provided suggestions for possible interventions to reduce the under-5 mortality rate and to introduce changes to the Health Sector Reform in Yemen.
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