Caregivers’ Treatment-Seeking Time for Diarrhea in Under-Five Children in Uganda: A Multilevel Proportional Hazards Analysis

Abstract

Abstract Background Diarrhea is considered to be one of the major public health concern in developing countries. It is attributed to one of the highest mortality rates among children both globally and in Sub-Sahara Africa with 2 in 10 children in Uganda under the age of 5 dying. The objective of this study was to investigate the factors associated with time to seeking treatment among children under the age of five years suffering from diarrhea in Uganda. Method DOVE dataset of 746 caretakers in a prospective cohort study using multi stage sampling design was used in the assessment. The analysis was done using a time-to-event approach using life tables and multilevel proportional hazards model. Results The median time to seeking treatment by the time of the study (N = 746) was 2 days (range, 1–30 days) from the onset of diarrhea. The estimated frailty variance is 0.128, indicating heterogeneity across regions. Significant factors found to influence time to diarrhea treatment seeking include male children (HR = 0.821; 95% CI = 0.707–0.954, p = 0.010), those from richest wealth quintile (HR = 1.372; 95% CI = 1.051–1.791, p = 0.020), those living 5–10 KM from health facility (HR = 0.613; 95% CI = 0.411–0.912, p = 0.016), and those living more than 15 KM from health facility (HR = 0.695; 95% CI = 0.553–0.875, p = 0.002). Conclusions The findings are informative to policy on the behavior of seeking treatment. The results are also important in formulation of program strategies and interventions by different stakeholders that are geared towards reducing child morbidity and mortality due to diarrhea in relation to seeking treatment. The study also recommends other researchers to consider mixed methods analysis involving both qualitative and quantitative approach may provide a better understanding about the treatment seeking behaviors.