In our study, the overall prevalence of childhood illnesses among under-five children preceding two weeks of the survey was 16.5%. Of the illnesses, 6.5% were diarrhea, 7.5% were ARI, and 12.0% were fever.. When we compared this finding with the reports from Ethiopian Demographic and Health Survey, the prevalence of diarrhea and fever were higher than the national figures (%?), however the two weeks prevalence of ARI was comparable among children of under five years of age northwest Ethiopia (24).
A Systematic review and meta-analysis conducted in Ethiopia noted that a higher prevalence of childhood illness compared to the current finding. The systematic review included primary studies done in regions with high burden of childhood morbidities including Afar, Somali and rural Dire Dawa where health care access is limited. This might have been attributed for higher pooled prevalence of childhood illness.
Similarly, the result of this study noted lower prevalence of childhood illness compared to some studies conducted elsewhere (9, 11, 13, 16). There could be several explanations for the differences in prevalence of the illnesses with this findings and across literatures. For instance, the study in Tanzania included three remote districts located 200-400 kilometers from the capital of the country. All the three districts were predominantly rural and impoverished with poor transportation, infrastructure, and subsistence agriculture driven economy there by limited availability and poor access to health care services. Likewise, the study done in Kenya was from two slum areas where the majority of the residents seek health care outside of health institutions. They mainly visited local drug shops, faith based institutions, and to some extent private clinics. And evidences showed a strong relationship between increased occurrence of childhood morbidity and health seeking behavior outside of health institutions (25-27).
Furthermore, our finding noted lower prevalence of childhood illnesses, particularly childhood diarrhea, compared to different studies conducted at different regions and districts in Ethiopia (28-38). Sample size, year of study, and study setting were some of the factors for the differences in prevalence of childhood illnesses across literatures. For example, one of the studies cited above was conducted in three small kebeles and used only 405 care givers in the study.
The treatment seeking behavior of the mothers/caregivers for any of the childhood illness was 54%. Out of 370 children of under five years of age who had one or more childhood illnesses, mothers/caregivers sought care at health facilities for 63 (45%), 97 (37.60%), and 17 (10.33%)of children for diarrhea, fever, and ARI, respectively. Treatment seeking behavior from health care facilities in this study was consistent for diarrhea and fever but lower for ARI compared to the EDHS 2016 report. The lower care seeking behavior for ARI could be the mothers’ perception of mild illness of cough as common cold (39). This study has also noted that the treatment seeking behavior of the mothers/caregivers was lower compared to similar studies done elsewhere (26, 40-43). There could be several explanations for the differences in treatment seeking behavior of the mothers/caregivers for common child hood illness. For instance, visiting traditional healer first, financial constraint, perception that illness was not serious and the expectation that illness would recover soon were some of the possible reasons (25, 40, 44). However, treatment seeking behavior of the mothers/caregivers in our study was higher compared to similar studies conducted in other parts of the country elsewhere (7, 35, 45, 46). The possible reason is that some of the above studies were conducted in relatively urban areas where residents had better socioeconomic status, and good awareness and attitude to seek modern care for their children (46, 47).
Different category of factors including maternal socio-demographic characteristics, child related and household environmental factors were significantly associated with childhood illness. Accordingly, maternal age, number of children in the household, mother occupation, and distance from the nearest health center were the independent determinants of childhood illness.
In this study, it was noted a child lived in a family with three and/or more under-five children was more likely to have childhood illness than a household with only one child. This finding was supported with similar studies conducted elsewhere (36, 48-50). This could be explained by the fact that when the number of children in the household increases, it is expected that children could be more vulnerable to contamination because the quality of care and attention from parents decreases as mothers become incapable of caring for children. Furthermore, children who get the disease may easily transmit the disease to others who live in the same area.
Moreover, the odds of developing childhood illness among children of semi-skilled/skilled mother occupational status were 2.3 times compared with unskilled mothers. This finding was in agreement with previous studies (37, 50-52). This can be justified in that maternal occupation and income are factors that provide information about the level of autonomy of the woman that could empower herself to take care of her child (53, 54). However, this finding was in contrast with a study done in Ethiopia to determine risks of underfive diarrheal and fever morbidity (55). The possible reason is that mothers with skilled occupation were working at outside of their home and children of those mothers were not received the quality care by the servants/ care giver than were supposed to get from their mothers.
Occurrence of childhood illness was inversely associated with distance to health facility. Children who lived near to health facility received more care at the facility than those who lived far from a health facility (56, 57). These finding was also consistent with other data from previous reports (9, 28, 58). This can be explained by the fact that children living in families located far from health facilities are denied of the availability and get access to the preventive and treatment services for common health problems which in turn led to occurrence increased childhood morbidity.
Finally, this study was not without its limitation. Since data collections were based on mothers/caregivers responses that there could be a room for recall bias. Besides, had limitations about the actual symptoms of illnesses as defined in health care setting and also had gaps with respect to the actual and reported care seeking behavior of mothers/caregivers for childhood illness.
This study was not free of limitations. The morbidity data collected were subjective in the sense that morbidity data were based on the caregivers’ perception of illness without validation by medical personnel. Moreover, this study used a recall period for six weeks and data was based on self-reported treatment seeking patterns, thus susceptible to recall bias and social desirability bias.