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The Journal of Health, Population and Nutrition
ISSN: 1606-0997
EISSN: 1606-0997
Vol. 32, No. 1, 2014, pp. 68-78
Bioline Code: hn14009
Full paper language: English
Document type: Research Article
Document available free of charge

The Journal of Health, Population and Nutrition, Vol. 32, No. 1, 2014, pp. 68-78

 en Potential Barriers to Healthcare in Malawi for Under-five Children with Cough and Fever: A National Household Survey
Ustrup, Marte; Ngwira, Bagrey; Stockman, Lauren J.; Deming, Michael; Nyasulu, Peter; Bowie, Cameron; Msyamboza, Kelias; Meyrowitsch, Dan W.; Cunliffe, Nigel A.; Bresee, Joseph & Fischer, Thea K.


Failure to access healthcare is an important contributor to child mortality in many developing countries. In a national household survey in Malawi, we explored demographic and socioeconomic barriers to healthcare for childhood illnesses and assessed the direct and indirect costs of seeking care. Using a cluster-sample design, we selected 2,697 households and interviewed 1,669 caretakers. The main reason for households not being surveyed was the absence of a primary caretaker in the household. Among 2,077 children aged less than five years, 504 episodes of cough and fever during the previous two weeks were reported. A trained healthcare provider was visited for 48.0% of illness episodes. A multivariate regression model showed that children from the poorest households (p=0.02) and children aged >12 months (p=0.02) were less likely to seek care when ill compared to those living in wealthier households and children of higher age-group respectively. Families from rural households spent more time travelling compared to urban households (68.9 vs 14.1 minutes; p<0.001). In addition, visiting a trained healthcare provider was associated with longer travel time (p<0.001) and higher direct costs (p<0.001) compared to visiting an untrained provider. Thus, several barriers to accessing healthcare in Malawi for childhood illnesses exist. Continued efforts to reduce these barriers are needed to narrow the gap in the health and healthcare equity in Malawi.

Healthcare surveys; Health expenditure; Health services accessibility; Malaria; Pneumonia; Malawi

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