Applying an equity and gender lens for pediatric careseeking in Afghanistan

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.