|Exploring the association between sick child healthcare utilisation and health facility quality in Malawi: a crosssectional study|
||Lingrui Liu, Hannah H Leslie, Martias Joshua, and Margaret E Kruk
||BMJ Open, 9: e029631; DOI: 10.1136/bmjopen-2019-029631
Health care utilization
||Objective Increasing the availability of basic healthcare
services in low-and middle-income countries is not
sufficient to meet the Sustainable Development Goal
target for child survival in high-mortality settings, where
healthcare utilisation is often inconsistent and quality of
care can be poor. We assessed whether poor quality of
sick child healthcare in Malawi is associated with low
utilisation of sick child healthcare.
Design We measured two elements of quality of sick child
healthcare: facility structural readiness and process of
care using data from the 2013 Malawi Service Provision
Assessment. Overall quality was defined as the average
of these metrics. We extracted demographic data from
the 2013–2014 Malawi Multiple Indicator Cluster Survey
and linked households to nearby facilities using geocodes.
We used logistic regression to examine the association
of facility quality with utilisation of formal health services
for children under 5 years of age suffering diarrhoea,
fever or cough/acute respiratory illness, controlling for
demographic and socioeconomic characteristics. We
conducted sensitivity analyses (SAs), modifying the travel
distance and population—facility matching criteria.
Setting and population 568 facilities were linked with
9701 children with recent illness symptoms in Malawi, of
whom 69% had been brought to a health facility.
Results Overall, facilities showed gaps in structural
quality (62% readiness) and major deficiencies in process
quality (33%), for an overall quality score of 48%.
Better facility quality was associated with higher odds
of utilisation of sick child healthcare services (adjusted
ORs (AOR): 1.66, 95% CI: 1.04 to 2.63), as was structural
quality alone (AOR: 1.33, 95% CI: 0.95 to 1.87). SAs
supported the main finding.
Conclusion Although Malawi’s health facilities for curative
child care are widely available, quality and utilisation
of sick child healthcare services are in short supply.
Improving facility quality may provide a way to encourage
higher utilisation of healthcare, thereby decreasing
preventable childhood morbidity and mortality.