Factors associated with late presentation to Kenyatta National Hospital for acute severe illness in children aged 2-59 months
Background: Delay in seeking appropriate healthcare for ill children is an important cause of morbidity and mortality especially for those aged below five years. Many factors contribute to these delays. Understanding these factors in any particular setting is helpful to enable the concerned health worker(s) address the caretaker concerns insofar as this leads to late care seeking for illness with its subsequent implications. Objective: To determine the factors associated with late healthcare seeking behaviour among severely ill children aged 2-59 months presenting to Kenyatta National hospital. Design: A hospital-based case control study. Setting: The Paediatric filter clinic and the paediatric medical wards at the Kenyatta National Hospital (KNH). Subjects: Children aged 2- 59 months who were brought to the hospital with acute severe illness and their caretakers. A total of 316 caretakers and their ill children were enrolled into the study between November 2007 and February 2008. Results: Of the 316 caretakers interviewed, 301 (95%) were mothers, the rest were other relatives. Among their ill children, 177 (56%) were boys, the rest were girls. The median age for the controls was 10 months, and 7 months for the cases. Symptoms of cough and diarrhoea were likely to be associated with presentation later than 3 days with OR of2.09 (CI 1.23-3.56) and 1.57(CI 1.01-2.73) respectively. Herbal Medicine was used by 5% of the study population and was associated with marked likelihood of late presentation [OR 41.7(CI 4.70-369.1)]. On outcome, there was enhanced chance of death in the cases compared to the controls [OR 4.69 (CI 1.62-14.6)]. The median length of hospital stay was longer for the cases (7 days vs 5 days) p=0.05. Conclusion: Caretakers bringing their acute severely ill children later than 3 days since illness onset to KNH are more likely to have explored other healthcare options first compared to similarly ill children brought within 3 days. These severe presentations include severe dehydration, severe respiratory distress among others. Cases had more adverse outcomes in terms of mortality and length of morbidity as reflected by the longer periods of hospitalization. Recommendation: Education of mothers and health caregivers at the peripheral health facilities on the aspects of community IMCI will promote timely referral for ill children.