ArticlePloS one2018
Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.
- Place of death, care-seeking and care pathway progression in the final illnesses of children under five years of age in sub-Saharan Africa: a systematic review.Journal of global health · 2019Pooled it
- Community-based amoxicillin treatment for fast breathing pneumonia in young infants 7-59 days old: a cluster randomised trial in rural Bangladesh, Ethiopia, India and Malawi.BMJ global health · 2021Trial
- Prevalence and factors associated with domestic accidents in children in the district of Orodara, Burkina Faso.BMC public health · 2026Article
- Assessment of childhood pneumonia management and outcomes at primary healthcare centres in Islamabad and Rawalpindi: an observational cohort study from Pakistan.Journal of global health · 2026Observational
- Morbidity and unplanned healthcare encounters after hospital discharge among young children in Dar es Salaam, Tanzania and Monrovia, Liberia.BMJ paediatrics open · 2024Observational
- Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1-59 months.PLOS global public health · 2024Article
- Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo.PLoS neglected tropical diseases · 2023Article
- Predictors for achieving adequate antenatal care visits during pregnancy: a cross-sectional study in rural Northwest Rwanda.BMC pregnancy and childbirth · 2023Article
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- Healthcare-seeking behavior for children aged 0-59 months: Evidence from 2002-2017 Indonesia Demographic and Health Surveys.PloS one · 2023Article
- A Prospective, observational cohort study to identify neonates and children at risk of postdischarge mortality in Dar es Salaam, Tanzania and Monrovia, Liberia: the PPDM study protocol.BMJ paediatrics open · 2022Article
- Health care seeking behaviour for children with acute childhood illnesses and its relating factors in sub-Saharan Africa: evidence from 24 countries.Tropical medicine and health · 2021Article
- Factors associated with delays in the search for care in under-5 deaths in Yucatán, Mexico.Salud publica de Mexico · 2021Article
- Distance to primary care facilities and healthcare utilization for preschool children in rural northwestern Burkina Faso: results from a surveillance cohort.BMC health services research · 2021Article
- Estimating hospital catchments from in-patient admission records: a spatial statistical approach applied to malaria.Scientific reports · 2020Article
- Projected impact and cost-effectiveness of community-based versus targeted azithromycin administration strategies for reducing child mortality in sub-Saharan Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Risk factors for mortality among Tanzanian infants and children.Tropical medicine and health · 2020Article
- All-cause child mortality in minority and non-minority areas in Sichuan Province in Western China, 2008-2017.Scientific reports · 2019Article
- Unintentional injury mortality among children under age five in urban and rural areas in the Sichuan province of west China, 2009-2017.Scientific reports · 2019Article
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Authors and funding
12 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOver half of under-five deaths occur in sub-Saharan Africa and appropriate, timely, quality care is critical for saving children's lives. This study describes the context surrounding children's deaths from the time the illness was first noticed, through the care-seeking patterns leading up to the child's death, and identifies factors associated with care-seeking for these children in rural Rwanda.
methodsSecondary analysis of a verbal and social autopsy study of caregivers who reported the death of a child between March 2013 to February 2014 that occurred after discharge from the child's birth facility in southern Kayonza and Kirehe districts in Rwanda. Bivariate analyses using Fisher's exact tests were conducted to identify child, caregiver, and household factors associated with care-seeking from the formal health system (i.e., community health worker or health facility). Factors significant at α = 0.10 significance level were considered for backwards stepwise multivariate logistic regression, stopping when remaining factors were significantly associated with care-seeking at α = 0.05 significance level.
resultsAmong the 516 eligible deaths among children under-five, 22.7% (n = 117) did not seek care from the health system. For those who did, the most common first point of contact was community health workers (45.8%). In multivariate logistic regression, higher maternal education (OR = 3.36, 95% CI: 1.89, 5.98), having diarrhea (OR = 4.21, 95%CI: 1.95, 9.07) or fever (OR = 2.03, 95%CI: 1.11, 3.72), full household insurance coverage (3.48, 95%CI: 1.79, 6.76), and longer duration of illness (OR = 22.19, 95%CI: 8.88, 55.48) were significantly associated with formal care-seeking.
conclusionInterventions such as community health workers and insurance promote access to care, however a gap remains as many children had no contact with the health system prior to death and those who sought formal care still died. Further efforts are needed to respond to urgent cases in communities and further understand remaining barriers to accessing appropriate, quality care.
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