Tohoku J. Exp. Med., 2009, 217(1)

Improvement in Mothers' Immediate Care-Seeking Behaviors for Children's Danger Signs through a Community-Based Intervention in Lusaka, Zambia

YASUYUKI FUJINO,¹ SATOSHI SASAKI,¹ KUMIKO IGARASHI,¹ NAOHITO TANABE,¹ CLARA MBWILI MULEYA,² BUSHIMBWA TAMBATAMBA² and HIROSHI SUZUKI¹

¹Division of Public Health, Department of Infectious Disease Control and International Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
²Lusaka District Health Management Team, Ministry of Health, Lusaka, Zambia

The large number of child deaths in developing countries is associated with delays in care-seeking by families, but the community-based efforts of the Integrated Management of Childhood Illnesses developed by WHO/UNICEF has remained ineffectual. To improve caregivers' ability to recognise potentially life-threatening symptoms of major childhood illnesses, we provided education about the importance of danger signs and immediate care-seeking practices through a community-based intervention of ‘the Growth Monitoring Programme Plus (GMP+)' in low-income areas of Lusaka, Zambia. Using repeated cross-sectional data from interviews, we compared attendance and non-attendance groups to assess the impacts of intervention on mothers' care-seeking. Of 1717 and 1546 attendance mothers in the baseline and the final survey, 1097 and 1035, respectively, sought care from a health centre after perceiving the danger signs. The proportion of mothers with immediate response increased from 35.7% (392/1097) to 51.5% (533/1035) (p < 0.01). In the final survey, the attendance mothers became more likely to respond immediately to the danger signs than the non-attendance mothers (adjusted odds ratio: 2.140, 95% confidence interval: [1.408-3.252]), and the higher educational level the attendance mothers had, the more likely they were to respond immediately to the danger signs (primary level: 2.067 [1.050-4.068], secondary level and above: 2.174 [1.098-4.306]). In conclusion, GMP+ with danger sign education can improve mothers' care-seeking for severely sick children. Therefore, GMP+ has the potential to reduce child death in developing countries, i.e., contribute to the Millennium Development Goal 4 aiming at reducing child mortality by two-thirds by 2015.

keywords —— child death; care-seeking; danger sign; Integrated Management of Childhood Illnesses (IMCI); Millennium Development Goal 4.

© 2009 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2009, 217, 73-85

Correspondence: Yasuyuki Fujino, Division of Public Health, Department of Infectious Disease Control and International Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo Ward, Niigata City, Niigata Prefecture, 951-8510, Japan.

e-mail: yfe10250@nifty.com