259101 Applying an equity and gender lens for pediatric careseeking in Afghanistan

Monday, October 29, 2012 : 8:45 AM - 9:00 AM

Anbrasi Edward, PhD, MPH, MBA , International Health, Johns Hopkins University, Baltimore, MD
Melissa Roach, MSPH , Department of International Health, Johns Hopkins University, Baltimore, MD
Essa Tawfiq, MD, MPH , International Health, Johns Hopkins University, Kabul, Kabul, Afghanistan
Ahmad Shah Salehi, MD, MSc , Health Economics and Financing Directorate, Ministry of Public Health, Afghanistan, Kabul, Afghanistan
Gilbert M. Burnham, MD, PhD , International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
David Peters, MD, DrPH , International Health, Johns Hopkins University, Baltimore, MD
For over a decade, investments have been made to revamp health infrastructure and service delivery to ensure access and quality for the rural poor in Afghanistan. Through contracting mechanisms the delivery of a basic package of health services has achieved significant improvements in coverage for reproductive and child health services. Employing multilevel probability sampling, 7057 households were selected in communities within the public health facility catchment areas in nine provinces, in 2010. Preferential careseeking for common pediatric conditions and average costs of payment were examined based on the wealth quintile of the respondents. Results: Commonly reported conditions were those targeted by IMCI: diarrhea (7%), fever (26%) and cough (30%), with significantly lower levels of careseeking for children in the poorest quintile, though a majority sought care from public facilities. Primary reasons for not seeking care were perceived seriousness of illness (35%), lack of transport (49%) and lack of finances (41%). Multivariate analysis controlling for age and literacy of the mother and child age, illustrated that the strongest predictors for careseeking were wealth (upper 4/5ths wealth quintile OR 1.9, p <0.001), gender (males OR 1.2, p <0.05) and type of illness (Diarrhea and Respiratory illness, OR 2.8, p <0.001, and other conditions OR 2.2, p<0.001). Preferential careseeking for male children and higher payments were evident. Reported distress financing was significantly higher in the poorest quintile for hospitalizations. Additional efforts to strengthen community IMCI services and other educational measures are warranted to ensure that the poor seek care and ensure gender equity.

Learning Areas:
Provision of health care to the public
Public health or related research

Learning Objectives:
1.Describe gender and wealth differences in illness careseeking practices for children 2.To compare differences in distress spending for healthcare based on socioeconomic status.

Keywords: Care Seeking, Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have supported the desing, implementation and analysis of the research as a co-principle investigator
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.