Research Problem

• According to the WHO, 5.6 million children under the age of 5

years died in 2016. This translates into 15 000 under-five deaths
per day.
• Leading causes of death in children under-5 years are preterm
birth complications, pneumonia, birth asphyxia, diarrhoea and
malaria.
• A child's risk of dying is highest in the first 28 days of life (the
neonatal period). Improving the quality of antenatal care, care
at the time of childbirth, and postnatal care for mothers and
their newborns are all essential to prevent these deaths.
Globally 2.6 million children died in the first month of life in
2016. There are approximately 7 000 newborn deaths every day,
amounting to 46% of all child deaths under the age of 5-years.
• Preterm birth, intrapartum-related complications (birth
asphyxia or lack of breathing at birth), and infections cause
most neonatal deaths. From the end of the neonatal period and
through the first 5 years of life, the main causes of death are
pneumonia, diarrhoea and malaria. Malnutrition is the
underlying contributing factor, making children more vulnerable
to severe diseases.

• The world has made substantial progress in child survival since

1990. The global under-5 mortality rate has dropped by 56 per
cent from 93 deaths per 1000 live births in 1990 to 41 in 2016.
Nonetheless, accelerated progress will be needed in more than
a quarter of all countries, to achieve the Sustainable
Development Goal (SDG) target (1) on under-five mortality by
2030. Meeting the SDG target would reduce the number of
under-5 deaths by 10 million between 2017 and 2030.
WHO response
• WHO calls on to address health equity through universal
health coverage so that all children are able to access essential
health services without undue financial hardship. Moving from
“business as usual” to innovative, multiple, and tailored
approaches to increase access, coverage, and quality of child
health services will require strategic direction and an optimal
mix of community and facility based care. Health sector and
multisectoral efforts are also needed to overcome the
inequalities and the social determinants of health.
Leading Causes of Neonatal Deaths in Zamboanga City, 2013
(Rate per 1,000 Live Births)

Diagnosis Male Female Deaths Rate

Prematurity 7 8 15 0.708

Neonatal Sepsis 3 1 4 0.189

Asphyxia 0 2 2 0.094
Abortus 0 1 1 0.047
Aspiration Pneumonia 0 1 1 0.047

Congenital Anomaly 0 1 1 0.047

Neonatal Pneumonia 1 0 1 0.047

Total 11 15 26 1.227
Leading Causes of Infant Deaths in Zamboanga City, 2013
(Rate per 1,000 Live Births)

Diagnosis Male Female Deaths Rate

Pneumonia 23 19 42 1.98

Neonatal Sepsis 11 10 21 0.99

8 10 18 0.85
Prematurity
Acute Gastro Enteritis 6 6 12 0.57
Sepsis 7 3 10 0.47
Asphyxia 1 6 7 0.33
Badjaos in Mariki, Zamboanga City

• The indigenous people such as the Badjaos are considered one

of the underprivileged group in the Philippines. This tribe is
known as the Sea Gypsies or Sea Nomads who for thousand of
years are still living in the sea where they are free from
everyday rejection and hardship brought about upon by other
tribes that live on land.

• Due to the frightening health situation among children in

Zamboanga City plus the living condition of Badjaos, the rates
of various infections among the tribe population are
heightened.
Source of the Problem

• Healthcare seeking behavior is of prime importance and is a

pivotal in the well-being of the individual and as a community.
• However, success in reducing childhood mortality needs more
than the availability of adequate health services with well-
trained health professionals. As families are the first people
responsible for child care, success requires a partnership
between health workers and families with community
support.
Objectives and Significance of the study
Objective:
• The main objective of this study is to explore the health
behaviors of the Badjao Mothers in managing common
childhood illnesses since these will illustrate strong
implications on their health situation and health needs.

• To determine out their level of knowledge on danger signs in

children that needs medical attention immediately.

• To reduce risk of under-five mortality among Badjaos in

Mariki, Z.C.
Summary of Related Literatures
• 1. Knowledge of danger signs in newborns and health seeking
practices of mothers and care givers in Enugu state, South-East
Nigeria Uchenna Ekwochi1†, Ikenna K Ndu1†, Chidiebere DI
Osuorah2*†, Ogechukwu F Amadi1, Ifeyinwa B Okeke1, Ejike
Obuoha1, Kenechi S Onah3, Ikenna Nwokoye4, Odutola I
Odetunde5 and Nnenne I Obumneme-Anyim5
• Abstract Background: According to UNICEF, 40% of all under-5
deaths occur within the first month of life and half of these within
the first few days of life. Many of these deaths are related to late
recognition of neonatal illness, delays in decision to seek care at
household level and subsequent late intervention at healthcare
facilities. Knowledge of mothers about the danger signs in
newborn is imperative to reduce these delays and preventable
deaths.
• Aim: This study aimed to assess the perception of mothers
and/or care givers of danger signs in newborns and their
knowledge of the WHO recognized danger. A secondary aim
was to explore the socio-demographic factors of mothers that
influence knowledge of the WHO recognized danger signs and
the health seeking behaviors of these mothers and/or care-
givers.

• Methods: This was a community based descriptive and

analytical study which used a multistage sampling technique
to select 376 mothers and/or care-givers from four
communities in 4 of the 17 Local Government Areas (LGA) of
Enugu State. Logistic regression and chi-square was used in
testing associations between variables.
• Results: Knowledge of more than three of the nine WHO
recognized danger sign was poor (0.0-30.3%). Majority of the
mothers had knowledge of one (i.e. fever) WHO recognized
danger sign (95.2%). Knowledge of the WHO signs was not
significantly associated with maternal socio-demographic
variables considered in this study. Healthcare seeking
behaviour was significantly determined by knowledge of at
least one WHO recognized danger sign (OR 4.6 CI 1.1-18.7,
P=0.032). Cough, diarrhea and the excessive crying were the
most perceived and experienced non-WHO recognized
dangers signs among respondents.

• Conclusion: There is urgent need to strengthen the teaching

and training of expectant mothers across all maternal socio-
demographic variables on these danger signs and the most
appropriate measures to take when they occur.
• 2. Factors affecting the healthcare-seeking behavior of
mothers regarding their children in a rural community of
Darjeeling district, West Bengal

• Background: An ailing, unresponsive health system and the

existing social complexities, with considerable contextual
differences, are all pervasive in India. In health, these are
manifested as differences in morbidity and mortality, severely
affecting child health and survival.

• Objectives: To fi nd out the possible factors affecting the

health-seeking behavior of mothers with regard to their
children, in a rural community of Darjeeling district, and the
reasons for not seeking curative care for perceived sick
children.
• Materials and Methods: A cross-sectional, community-based
study among the mothers of the Naxalbari Block was
undertaken, using a multistage random sampling technique,
from June to August 2011, by using the questionnaire method.
A total of 256 mothers (sample size) were studied.

• Results: Joint family structure, mass media exposure, literacy

status, socioeconomic status of mothers, and gender
differences among children were found to be signifi cantly
associated with the healthcare-seeking behavior of the
mothers.

• Conclusion: Increasing maternal education, intensifi ed

awareness generation through the mass media approach,
implementing gender-sensitive interventions, and counseling,
may have positive implications in future, leading to better
health outcomes and favorable health indicators.
• 3. Health seeking behaviour and challenges in utilising health
facilities in Wakiso district, Uganda.
• Musoke D1, Boynton P2, Butler C2, Musoke MB3.

• Abstract
• BACKGROUND:
• The health seeking behaviour of a community determines how they
use health services. Utilisation of health facilities can be influenced by
the cost of services, distance to health facilities, cultural beliefs, level
of education and health facility inadequacies such as stock-out of
drugs.
• OBJECTIVES:
• To assess the health seeking practices and challenges in utilising
health facilities in a rural community in Wakiso district, Uganda.
• METHODS:
• The study was a cross sectional survey that used a structured
questionnaire to collect quantitative data among 234 participants.
The sample size was obtained using the formula by Leslie Kish.
• RESULTS:
• While 89% of the participants were aware that mobile clinics
existed in their community, only 28% had received such
services in the past month. The majority of participants (84%)
did not know whether community health workers existed in
their community. The participants' health seeking behaviour
the last time they were sick was associated with age (p =
0.028) and occupation (p = 0.009). The most significant
challenges in utilising health services were regular stock-out of
drugs, high cost of services and long distance to health
facilities.
• CONCLUSIONS:
• There is potential to increase access to health care in rural
areas by increasing the frequency of mobile clinic services and
strengthening the community health worker strategy.
• 4. Health Seeking Behaviour of Mothers of Under-Five-Year-
Old Children in the Slum Communities of Nairobi, Kenya.
• Amuyunzu-Nyamongo M, Nyamongo IK.

• Abstract
• Prompt and appropriate health seeking is critical in the
management of childhood illnesses. This paper examines the
health seeking behaviour in under-five child morbidity. It
explores in detail actions taken by 28 mothers when their
children become sick. Sixty-two in-depth interviews with
mothers were conducted from four study communities. The
mothers were identified from a demographic surveillance
system.
• The interviews were tape-recorded, transcribed and
thematically analysed. The study shows that mothers classify
childhood illnesses into four main categories: (1) not serious-
coughs, colds, diarrhoea; (2) serious but not life-threatening-
malaria; (3) sudden and serious-pneumonia; and (4) chronic
and therefore not requiring immediate action-malnutrition,
tuberculosis, chronic coughs.

• This classification is reflected in the actions taken and time it

takes to act. Shops are used as the first source of healthcare,
and when the care moves out of the home, private health
facilities are used more compared to public health facilities,
while even fewer mothers consult traditional healers.
• Consequently we conclude that there is a need to train
mothers to recognize potentially life-threatening conditions
and to seek appropriate treatment promptly. Drug vendors
should be involved in intervention programs because they
reach many mothers at the critical time of health seeking.
• 5. Factors affecting health seeking behavior for common childhood
illnesses in Yemen.
• Webair HH1, Bin-Gouth AS.

• Abstract
• INTRODUCTION:
• Appropriate medical care seeking could prevent a significant number
of child deaths and complications due to ill health. This study aims to
determine factors affecting health seeking behavior (HSB) for
childhood illnesses, thereby improving child survival.
• METHODS:
• A cross sectional study was carried out from January 11 to April 2,
2012. A total of 212 caretakers of children under the age of 5 years
participated. Caretakers who visited the vaccination unit in the
Shehair Health Center during the study period and had a child with a
history of diarrhea, fever, cough, and/or difficulty of breathing during
the last 14 days were included. The data were collected by
interviewing caretakers and the answers were reported in pretested
structured questionnaires.
• RESULTS:
• Medical care was sought for about half of the sick children (n=109,
51.42%). Seeking medical care was frequently initiated for illnesses
that did not improve or worsened. The major reasons for not
seeking medical care were "illness was mild" (n=40, 38.83%) and
"illness is not for medical treatment" (n=32, 31.07%). The
caretakers sought medical care significantly more when they had a
higher level of school education (POR [prevalence odds ratio] 5.85,
95% CI [confidence interval]: 2.34-14.61), when the illness was
perceived as severe (POR 5.39, 95% CI: 2.81-10.33), and when the
child had difficulty of breathing (POR 2.93, 95% CI: 1.10-7.80).
• CONCLUSION:
• For the preventable childhood illnesses with existing interventions,
appropriate HSB prevalence is low. Symptom type, caretakers'
education, and perception of illness severity are the predictors of
HSB. Educational improvement of the mothers, introduction of
community based integrated management of childhood illness, and
in-depth research are imperative to improve mothers' HSB.
Theories related to the study

• Definition and Rationale for the Health Belief Model

• The Health Belief Model (HBM) is one of the most widely used
conceptual frameworks for understanding health behavior.
Developed in the early 1950s, the model has been used with
great success for almost half a century to promote greater
condom use, seat belt use, medical compliance, and health
screening use, to name a few behaviors.
• The HBM is based on the understanding that a person will take
a health-related action, if that person feels that a negative
health condition can be avoided.

• has a positive expectation that by taking a recommended

action, he/she will avoid a negative health condition and

• believes that he/she can successfully take a recommended

health action
• The Health Belief Model is a framework for motivating people
to take positive health actions that uses the desire to avoid a
negative health consequence as the prime motivation.

• The HBM can be an effective framework to use when

developing health education strategies.