Parental behaviors regarding fever in young children in Benin: study of population survey data.

Introduction: the search for care of parents in case of the febrile episode of children is not always systematic. This study aims to improve knowledge on health care research in cases of fever in children under five years of age in Benin. Methods: this study used data from the Benin Demographic and Health Survey 2017-2018. Counselling or seeking care is defined as any child under 5 years of age who has a fever in the two weeks prior to the interview. Univariate and multivariate logistic regression analyses were performed using generalized linear model. Results: a total of 2465 children were surveyed. The model predicting seeking appropriate advice or care in febrile children in Benin was distance from the nearest health center, region, maternal age, and socioeconomic status. Indeed, febrile children whose mothers perceived difficult geographical access to the health center were 30% less likely to seek care, compared to children whose geographical access to the health center was easy (aOR=0.70 (0.54-0.90)). In addition, mothers living in the Hill region were more likely (AOR=5.73 (3.53-9.45)) to seek appropriate advice or care compared to those living in Alibori. In terms of socioeconomic status, children whose mothers were very wealthy were more likely to have their mothers seek care (aOR=1.93 (1.33-2.81)). Conclusion: interventions to improve universal primary health care coverage in terms of geographic accessibility, awareness and health literacy are the best allies for routine care.

Use of a digital job-aid in improving antenatal clinical protocols and quality of care in rural primary-level health facilities in Burkina Faso: a quasi-experimental evaluation.

OBJECTIVE: We assessed the impact of a digital clinical decision support (CDS) tool in improving health providers adherence to recommended antenatal protocols and service quality in rural primary-level health facilities in Burkina Faso. DESIGN: A quasi-experimental evaluation based on a cross-sectional post-intervention assessment comparing the intervention district to a comparison group. SETTING AND PARTICIPANTS: The study included 331 direct observations and exit interviews of pregnant women seeking antenatal care (ANC) across 48 rural primary-level health facilities in Burkina Faso in 2021. INTERVENTION: Digital CDS tool to improve health providers adherence to recommended antenatal protocols. OUTCOME MEASURES: We analysed the quality of care on both the supply and demand sides. Quality-of-care service scores were based on actual care provided and expected care according to standards. Pregnant women's knowledge of counselling and satisfaction score after receiving care were also calculated. Other outcomes included time of clinical encounter. RESULTS: The overall quality of health service provision was comparable across intervention and comparison health facilities (52% vs 51%) despite there being a significantly higher proportion of lower skilled providers in the intervention arm (42.5% vs 17.8%). On average, ANC visits were longer in the intervention area (median 24 min, IQR 18) versus comparison area (median 12 min, IQR: 8). The intervention arm had a significantly higher score difference in women's knowledge of received counselling (16.4 points, 95% CI 10.37 to 22.49), and women's satisfaction (16.18 points, 95% CI: 9.95 to 22.40). CONCLUSION: Digital CDS tools provide a valuable opportunity to achieve substantial improvements of the quality of ANC and broadly maternal and newborn health in settings with high burden mortality and less trained health cadres when adequately implemented.

Care-seeking behaviour among febrile children under five in Togo.

BACKGROUND: Fever is one of the warning signs of poor health in children. Care-seeking in febrile children is importance in reducing child deaths and morbidity. This care-seeking by parents in children with fever is however relatively low in sub-Sahara Africa. The aim of this study is to improve understanding of the behaviour of caregivers in seeking care for children under five with fever and to identify associated modifiable risk factors in Togo. METHODS: Data from a 2013-2014 cross-sectional nationally representative malaria indicator survey was used. Advice or care-seeking is defined as any child under 5 years of age with fever in the two weeks prior to the interview for whom advice or treatment was sought in a public medical area, private medical area, store, market, or from an itinerant medicine seller. Univariate and multivariate logistic regression analysis were performed using Generalized Linear Models. RESULTS: A total of 1359 febrile children out of 6529 children under five were enrolled. Care had been sought in 38.9% of cases. In multivariate analysis, independent risk factors associated with formal care seeking were accessibility to the nearest health center (aOR = 1.52, 95% CI [1.18-1.95], mother's education level secondary and above (aOR = 1.85, 95% [1.32-2.59]), mothers who identified as belonging to animist/traditionalist religions compared to mothers who belonged to a formal religion (catholic (aOR = 2. 28, 95% [1.55-3.37]), Muslim (aOR = 2.41, 95% [1.67-3.47]), and Protestant (aOR = 1.9, 95% [1.37-2.65]), Maritime region (aOR = 0.49, 95% [0.29-0.82]) compared to Lome commune. CONCLUSION: Interventions should specifically target women with limited education, not identifying as part of an official church and at longer distance from health center.