In our study, the overall prevalence of childhood illnesses among under-five children preceding two weeks of the survey was 16.5% (95% CI: 15.0, 18.2). Of the illnesses, 6.5% (95% CI: 5.5, 6.7) was accounted for diarrhea, 7.5% (95% CI: 6.5, 8.8) was for ARI, and 12.0% (95% CI: 10.7, 13.4) was for fever. Compared to the national figure (EDHS 2016), the finding of this study noted , a higher prevalence of diarrhea and fever which was h 12% for diarrhea and 14% for fever. However, the two weeks prevalence of ARI in this study was comparable with the national figure (7.5%) (24).
A Systematic review and meta-analysis conducted in Ethiopia noted a higher prevalence of childhood illness compared to the current finding (28). The systematic review included primary studies done in regions with a high burden of childhood morbidities including Afar, Somali, and rural Dire Dawa where health care access is limited. This might have been attributed to the higher pooled prevalence of childhood illnesses.
Similarly, the result of this study noted a lower prevalence of childhood illness compared to some studies conducted elsewhere (9, 11, 13, 16, 29). There could be several explanations for the differences in the prevalence of the illnesses with the current finding and across works of literature. For instance, the study in Tanzania included three remote districts located 200-400 kilometers from the capital of the country. All three districts were predominantly rural and impoverished with poor transportation, infrastructure, and subsistence agriculture is driven economy thereby 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 pieces of evidence showed a strong relationship between the increased occurrence of childhood morbidity and health-seeking behavior outside of health institutions (30-32). Besides, the study in Nigeria included a small sample of caregivers (450) in a single setting of a local government area, Lagos State, and included all children aged 0-5 years. This might overestimate the proportion of illnesses compared to our findings.
Furthermore, our finding noted the lower prevalence of childhood illnesses, particularly childhood diarrhea, compared to different studies conducted in different regions and districts in Ethiopia (7, 25, 26, 33-42). Sample size, year of study, and study setting were some of the factors for the differences in the prevalence of childhood illnesses across our study and the aforementioned literature. For example, one of the studies (43) was conducted in three small kebeles and used only 405 caregivers in the study. Similarly the study from the Jeldu district of the Oromia region, Ethiopia was done on a relatively small sample size (422) caregivers might underestimate the magnitude of childhood illness compared to our findings.
Overall, about 22.7% [95%CI: 18.72, 27.42] of mothers/caregivers sought health care for the sick child. Treatment seeking behavior from health care facilities in this study was consistent for diarrhea and fever but lower for ARI compared to the EDHS report. The lower care-seeking behavior for ARI could be the mothers’ perception of mild illness of cough as the common cold (44). This study has also noted that the treatment-seeking behavior of the mothers/caregivers was lower compared to similar studies done elsewhere (29, 31, 45-47). There could be several explanations for the differences in treatment-seeking behavior of the mothers/caregivers for common childhood illness. Some of the possible reasons that affect common childhood illnesses are visiting traditional healer’s first, financial constraint, the perception that illness was not serious, and the expectations that illness would recover soon (29, 30, 48). However, the 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, 38, 49, 50). 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 (50, 51).
Different categories 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 that a child who 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 by similar studies conducted elsewhere (39, 52-54). This could be possibly explained in 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 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 (40, 54-56). The possible reason is that mothers with a skilled occupation usually work outside of their home which they might not have adequate time to care for their children as a motherhood role. As a result, children of those mothers might not receive the quality care from the servants/ caregiver than were supposed to get from their mothers. However, this finding was in contrast with a study done in Ethiopia to determine the risks of under-five diarrheal and fever morbidity in which children of mothers/caregivers with working status were more at risk of getting childhood illnesses (59).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 (57, 58).
The occurrence of childhood illness was inversely associated with distance to a health facility. Children who lived near health facilities received more care than those who lived far from a health facility (60, 61). This finding was also consistent with other data from previous reports (9, 33, 62). This can be explained by the fact that children living in families located far from health facilities are denied the availability and get access to the preventive and treatment services for common health problems which in turn led to the occurrence of increased childhood morbidity.
Different scholars have indicated that several factors were associated with the health-seeking behavior of mothers/caretakers for common childhood illnesses including maternal education level, family income, and perception of illnesses, residence, knowledge, and distance from health institutions. However, in the current study, mothers’ occupation was the only independent predictor of treatment-seeking behavior. Thus, the odds of having treatment-seeking behavior among semi-skilled/skilled mothers/care-givers were four (AOR= 4.08 (95% CI: 1.35, 12.39) times higher compared to unskilled mothers/care-givers. This finding was supported by previous studies (63, 64). This could be explained in that employed mothers usually have higher income and perhaps would be better educated and have enough resources for seeking treatment to their sick children in which they are more likely to visit health facilities for illnesses before it gets worse.
Finally, this study was not without its limitations. Since data collections were based on mothers/caregivers' responses that there could be room for recall bias and social desirability bias.
Furthermore, morbidity data were subjective since it was based on self-reported treatment-seeking patterns without validation by medical personnel. It is also difficult to establish a cause-effect relationship because of the cross-sectional nature of the data. Moreover, contextual factors like cultural practices and health-seeking for traditional medicine, and some children's data were not included. Despite these limitations, the findings of the study will be generalized to rural northwest Ethiopia and other similar settings.