PDF(Pubmed)
Abstract：
BACKGROUND: Diarrhea is considered to be one of the major public health concerns in developing countries. It has a detrimental impact, reflecting one of the highest child mortality rates globally, especially in Sub-Saharan Africa, where 2 out of every 10 children in Uganda under the age of five die. The objective of this study was to investigate the factors associated with time to treatment seeking by caretakers of children under-five with Diarrhea in Uganda.
METHODS: DOVE dataset of 745 caretakers in a prospective and retrospective incidence-based study using multi-stage sampling design was used in the assessment. The analysis was done using a time-to-event approach using life tables, Kaplan Meier survival analysis and multilevel proportional hazards model.
RESULTS: Kaplan-Meier survival analysis indicated the median time to seeking treatment among 745 caretakers of children under-Five after onset of diarrhea was 2 days. The multi-level proportional hazards model of a Weibull distribution showed that the estimated frailty variance was 0.13, indicating heterogeneity of treatment seeking time by caretakers of under-five children with diarrhea across regions in Uganda. Significant factors found to influence time to treatment-seeking by caretakers of children under-five with diarrhea were, male children (HR = 0.82; 95% CI = 0.71-0.95, p = 0.010), belonging to richest wealth quintile (HR = 1.37; 95% CI = 1.05-1.78, p = 0.022), and residing more than 5 km away from a health facility (HR = 0.68; 95% CI = 0.56-0.84, p = 0.000).
CONCLUSIONS: There are delays in seeking diarrhea treatment in Uganda because two days are enough to claim a life after dehydration.The policymakers should pay attention to formulate effective intervention to sensitize caregivers on the importance of early treatment-seeking behavior to avoid severe malnutrition caused by diarrhea. Community awareness program should also be encouraged particularly in areas of more than 5 km from the health facility to make people aware of the necessity to take prompt action to seek care in the early stage.
METHODS: DOVE dataset of 745 caretakers in a prospective and retrospective incidence-based study using multi-stage sampling design was used in the assessment. The analysis was done using a time-to-event approach using life tables, Kaplan Meier survival analysis and multilevel proportional hazards model.
RESULTS: Kaplan-Meier survival analysis indicated the median time to seeking treatment among 745 caretakers of children under-Five after onset of diarrhea was 2 days. The multi-level proportional hazards model of a Weibull distribution showed that the estimated frailty variance was 0.13, indicating heterogeneity of treatment seeking time by caretakers of under-five children with diarrhea across regions in Uganda. Significant factors found to influence time to treatment-seeking by caretakers of children under-five with diarrhea were, male children (HR = 0.82; 95% CI = 0.71-0.95, p = 0.010), belonging to richest wealth quintile (HR = 1.37; 95% CI = 1.05-1.78, p = 0.022), and residing more than 5 km away from a health facility (HR = 0.68; 95% CI = 0.56-0.84, p = 0.000).
CONCLUSIONS: There are delays in seeking diarrhea treatment in Uganda because two days are enough to claim a life after dehydration.The policymakers should pay attention to formulate effective intervention to sensitize caregivers on the importance of early treatment-seeking behavior to avoid severe malnutrition caused by diarrhea. Community awareness program should also be encouraged particularly in areas of more than 5 km from the health facility to make people aware of the necessity to take prompt action to seek care in the early stage.
摘要：
背景：腹泻被认为是发展中国家主要的公共卫生问题之一。它有不利的影响，反映了全球儿童死亡率最高的国家之一，尤其是在撒哈拉以南非洲，乌干达每10名五岁以下儿童中就有2人死亡。这项研究的目的是调查与乌干达五岁以下腹泻儿童看护人寻求治疗时间相关的因素。
方法：在一项前瞻性和回顾性的基于多阶段抽样设计的研究中，使用了745名看护者的DOVE数据集。分析是使用生命表使用时间到事件的方法进行的，KaplanMeier生存分析和多水平比例风险模型。
结果：Kaplan-Meier生存分析显示，745名五岁以下儿童看护者在腹泻发作后寻求治疗的中位时间为2天。Weibull分布的多级比例风险模型显示，估计的脆弱方差为0.13，表明乌干达各地区五岁以下腹泻儿童的看护人寻求治疗时间的异质性。发现影响五岁以下腹泻儿童看护人寻求治疗时间的重要因素是，男性儿童（HR=0.82；95%CI=0.71-0.95，p=0.010），属于最富有的财富五分之一(HR=1.37；95%CI=1.05-1.78，p=0.022)，并且居住在距医疗机构5公里以上的地方（HR=0.68；95％CI=0.56-0.84，p=0.000）。
结论：在乌干达寻求腹泻治疗有延误，因为两天足以在脱水后夺去生命。政策制定者应注意制定有效的干预措施，以使护理人员对早期寻求治疗行为的重要性敏感，以避免腹泻引起的严重营养不良。还应鼓励社区意识计划，特别是在距医疗机构5公里以上的地区，以使人们意识到必须迅速采取行动，在早期寻求护理。
方法：在一项前瞻性和回顾性的基于多阶段抽样设计的研究中，使用了745名看护者的DOVE数据集。分析是使用生命表使用时间到事件的方法进行的，KaplanMeier生存分析和多水平比例风险模型。
结果：Kaplan-Meier生存分析显示，745名五岁以下儿童看护者在腹泻发作后寻求治疗的中位时间为2天。Weibull分布的多级比例风险模型显示，估计的脆弱方差为0.13，表明乌干达各地区五岁以下腹泻儿童的看护人寻求治疗时间的异质性。发现影响五岁以下腹泻儿童看护人寻求治疗时间的重要因素是，男性儿童（HR=0.82；95%CI=0.71-0.95，p=0.010），属于最富有的财富五分之一(HR=1.37；95%CI=1.05-1.78，p=0.022)，并且居住在距医疗机构5公里以上的地方（HR=0.68；95％CI=0.56-0.84，p=0.000）。
结论：在乌干达寻求腹泻治疗有延误，因为两天足以在脱水后夺去生命。政策制定者应注意制定有效的干预措施，以使护理人员对早期寻求治疗行为的重要性敏感，以避免腹泻引起的严重营养不良。还应鼓励社区意识计划，特别是在距医疗机构5公里以上的地区，以使人们意识到必须迅速采取行动，在早期寻求护理。
