Many sick children in developing countries die simply because their parents do not seek medical care in time. The World Health Organisation states that child deaths due to acute respiratory infections can be reduced globally by 20 percent if prompt action is taken when a child first shows symptoms.  But how can parents be encouraged to use their local health services to treat their children? 

Action Research and Training for Health, Fatehpura, India, together with the World Health Organisation, carried out a study to discover the effects of health education on families in Udaipur, a rural district of Rajasthan. 12 clinics were chosen.  In six of the clinics doctors were trained in counselling, communication and clinical skills while the other six clinics were used as a control group. 2,460 children under the age of 5 brought for treatment by their mothers were recruited into the study.  Half of the families were given advice on what symptoms to look for in sick children and when it was necessary to seek medical help; the other half were used as a control group.

The study found that:

• There was little difference in the behaviour of the two groups when their children fell ill. 15 percent of mothers who had received counselling quickly took their sick children to the clinic for medical attention, while 10 percent of mothers from the control group also responded quickly.
• After one month of training the doctors’ counselling skills were more effective, but by six months the quality of counselling had declined. The doctors suggested that this was because it was hard to give advice to parents because at times they have patients crowding around them while they are working.
• 45 percent of mothers who received counselling could remember at least one of the danger signs to look out for in sick children, while only 8 percent of the mothers in the control group could remember having any danger signs explained to them.

While some mothers seemed to be more aware of the need to take sick children for prompt treatment, many did not put their knowledge to good use.  There was little change in their response to their children’s illnesses.  Other factors also play a part in whether parents seek medical treatment, for example, how far way the clinic is, and the cost of treatment.  In addition, changes in behaviour may take time to occur.  Families may need to receive health education over an extended period of time before they begin to adapt their behaviour.

The report recommends that:

• it is important that health education campaigns are developed to encourage parents to seek prompt medical care for their sick children
• access to clinics and the cost of treatment need to be considered when trying to understand parents’ behaviour
• doctors need to be given the space and time to tend to the needs of their patients.

Training rural doctors to counsel mothers on the dangers signs and when to seek medical care can improve women’s understanding of childhood illnesses.  However, in this particular study, it had little impact on the way mothers looked after their sick children.  There was little improvement in the number of families who brought their children promptly for medical attention.  Other avenues need to be explored to discover why parents do not seek medical care for their sick children.

Source(s):
'Impact of counselling on care-seeking behaviour in families with sick children: cluster randomised trial in rural India', British Medical Journal 329: 266, by P. Mohan et al, 2004

Funded by: Division of Child and Adolescent Health, World Health Organisation, Geneva

id21 Research Highlight: 3 March 2005

Further Information:
Pavitra Mohan
402 Sharda Regency Apartments
Mangal Marg
Bapu Nargar
Jaipur
India

Tel: +93 0141 270 0974
Contact the contributor: pmohan@unicef.org

Action Research and Training for Health, Fatehpura, India

World Health Organisation

Other related links:
'Danger in disguise – spotting the warning signs of severe childhood illnesses'

'Troubled teenagers? Young people's health service access and needs in China'

'Gloomy prospects – effects of postnatal depression on infants’ development'

'Sound advice: peer counsellors promote breastfeeding in Bangladesh'

'Lessons learned - what do we know about health education?'

'Fair play: removing inequities in child health'

See id21's collection of links relevant to maternal and child health.