Association between disability status and health care utilisation for common childhood illnesses in 10 countries in sub-Saharan Africa: a cross-sectional study in the Multiple Indicator Cluster Survey

Journal article

Background Approximately 70 million children in sub-Saharan Africa (SSA) are disabled, yet little is known about the prevalence of and care-seeking patterns for common childhood illnesses, such as acute respiratory infection (ARI), diarrhoea, and fever.

Methods Data were from 10 SSA countries with data available from 2017 to 2020 in the UNICEF-supported Multiple Indicator Cluster Survey (MICS) online repository. Children aged 2–4 years who completed the child functioning module were included. Using logistic regression, we examined the association between disability and ARI, diarrhoea and fever in the past two weeks and care-seeking behaviour for these illnesses. Using multinomial logistic regression, we examined the association between disability and the type of health care providers from which caregivers sought care.

Findings There were 51,901 children included. Overall, there were small absolute differences in illnesses between disabled and non-disabled children. However, there was evidence disabled children had a greater odds of ARI (aOR = 1.33, 95% C.I 1.16–1.52), diarrhoea (aOR = 1.27, 95% C.I. 1.12–1.44), and fever (aOR = 1.19 95% CI 1.06–1.35) compared to non-disabled children. There was no evidence that caregivers of disabled children had a greater odds of seeking care for ARI (aOR = 0.90, 95% C.I 0.69–1.19), diarrhoea (aOR = 1.06, 95% C.I. 0.84–1.34), and fever (aOR = 1.07, 95% C.I 0.88–1.30) compared to caregivers of non-disabled children. Caregivers of disabled children had a higher odds of seeking care from a trained health worker for ARI (aOR = 1.76, 95% C.I. 1.25–2.47) and fever (aOR = 1.49, 95% C.I. 1.03–2.14) or non-health professional (aOR = 1.89, 95% C.I. 1.19–2.98) for ARI than from an unspecified health facility worker compared to caregivers of non-disabled children, but no associations were not seen for diarrhoea.

Interpretation While the data showed relatively small absolute differences, disability was associated with ARI, diarrhoea and fever and caregivers of disabled children sought care from trained health workers for ARI and fever more than non-disabled children. The overall small absolute differences show closing gaps in illness and access to care may be possible, but highlights that more research on illness severity, care quality, and outcomes should be conducted to further assess health inequities for disabled children.

Funding SR receives funding from the Rhodes Trust.

Authors: Rotenberg, S; Davey, C; McFadden, E

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: EClinicalMedicine
• Volume: 57
• Article number: 101870
• Publication date: 2023-02-26
• Acceptance date: 2023-01-31
• DOI: 10.1016/j.eclinm.2023.101870
• EISSN: 2589-5370
• Language: English
• Keywords: fever; diarrhoeal disease; child illness; FFR; health equity; ARI; disability