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Determinants and pathways of healthcare-seeking behaviours in under-5 children for common childhood illnesses and antibiotic prescribing: a cohort study in rural India

Authors

  • Shweta Khare Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
  • Ashish Pathak Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
  • Manju Purohit Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
  • Megha Sharma Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
  • Gaetano Marrone Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
  • Ashok Tamhankar Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
  • Cecilia Lundborg Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
  • Vishal Diwan Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden

Keywords:

quality in health care, public health, community child health, primary care

Abstract

Objectives To explore the healthcare-seeking pathways, antibiotic prescribing and determine the sociodemographic factors associated with healthcare-seeking behaviour (HSB) of caregivers for common illnesses in under-5 (U-5) children in rural Ujjain, India. Study design Prospective cohort study. Study setting and study sample The cohort included 270 U-5 children from selected six villages in rural demographic surveillance site, of the R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. A community-based cohort was visited two times weekly for over 113 weeks (August 2014 to October 2016) to record the HSB of caregivers using HSB diaries. Sociodemographic information was also solicited. Primary and secondary outcome measures Primary outcomes: first point of care, healthcare-seeking pathway and quantify antibiotic prescribing for the common acute illnesses. Secondary outcome HSB risk factors were determined using mixed-effects multinomial logistic regression. Results A total of 60 228 HSB follow-up time points for 270 children were recorded with a total of 2161 acute illness episodes. The most common illnesses found were respiratory tract infections (RTI) (69%) and gastrointestinal tract infections (8%). No healthcare was sought in 33% of illness episodes, mostly for RTIs. The most common healthcare-seeking pathway was to informal healthcare providers (IHCPs, 49% of illness episodes). The adjusted relative risk for obtaining no treatment, home treatment and treatment by IHCPs was higher for RTIs (aRR=11.54, 1.82 and 1.29, respectively), illiterate mothers (aRR=2.86, 2.38 and 1.93, respectively), and mothers who were homemakers (aRR=2.90, 4.17 and 2.10, respectively). Socioeconomic status was associated with HSB, with the highest aRR for no treatment in the lowest two socioeconomic quintiles (aRR=6.59 and 6.39, respectively). Antibiotics were prescribed in 46% (n=670/1450) illness episodes and the majority (85%, n=572/670) were broad spectrum. Conclusion In our rural cohort for many acute episodes of illnesses, no treatment or home treatment was done, which resulted in overall reduced antibiotic prescribing. The most common healthcare-seeking pathway was to visit IHCPs, which indicates that they are major healthcare providers in rural areas. Most of the antibiotics were prescribed by IHCPs and were commonly prescribed for illnesses where they were not indicated. Keywords: quality in health care, public health, community child health, primary care, public health

Author Biographies

Shweta Khare, Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden

Department of Public Health and Environment, Ruxmaniben Deepchand Gardi Medical College, 456006 Ujjain, Madhya Pradesh, India

Ashish Pathak, Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden

Department of Women and Children’s Health, International Maternal and Child Health Unit, Uppsala University, Uppsala,SE-751 85, Sweden

Manju Purohit, Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden

Department of Pathology, Ruxmaniben Deepchand Gardi Medical College, 456006 Ujjain, Madhya Pradesh, India

Megha Sharma, Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden

Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, 456006 Ujjain, Madhya Pradesh, India

Ashok Tamhankar, Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden

Indian Initiative for Management of Antibiotic Resistance, Department of Environmental Medicine, Ruxmaniben Deepchand Gardi Medical College, 456006 Ujjain, Madhya Pradesh, India

Vishal Diwan, Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden

Division of Environmental Monitoring and Exposure Assessment (Water and Soil), ICMR—National Institute for Research in Environmental Health, 462030 Bhopal, Madhya Pradesh, India

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