Delays in health care seeking for diarrheal disease and associated factors among caregivers of under five children in health centers of northwest Ethiopia: a mixed-method study

Abstract

Background

Approximately 70% of child deaths due to diarrhea are caused by a lack of timely healthcare. However, there was little evidence of factors associated with delays in seeking health care for patients with diarrheal diseases in the study area. Therefore, this study aimed to investigate delays in seeking healthcare for children with diarrhea and identify associated factors among caregivers in health centers of Northwest Ethiopia.

Method and materials

An institution-based mixed study method was conducted from May to June 2022. Quantitative data were collected from 374 participants who were selected by systematic random sampling using a structured interviewer-administered questionnaire and chart review. The data were analyzed using the Statistical Package for Social Science software version 25. Bivariable and multivariable logistic regression models were used to identify associated factors. Variables with a p- value < 0.05 in the multivariable analysis were considered to be significantly associated. Qualitative data were collected from participants in waiting area after receiving treatments via in-depth interviews and analyzed using open-source software. The qualitative data were transcribed, translated, coded, thematized, and interpreted accordingly.

Results

In this study, 53.48% of patients experienced delays in seeking healthcare for diarrhea. A large family size (adjusted odds ratio (AOR) = 2.64, 95% CI: 1.26–5.4), poor knowledge about diarrhea danger signs (AOR = 3.25, 95% CI: 1.6–6.6), difficulty paying for treatment (AOR = 2.95, 95% CI: 1.6–5.3), not visiting health facilities as the first response to diarrhea (AOR = 3.94, 95% CI: 1.96–7.9), only diarrhea (AOR = 2.39, 95% CI: 1.01–5.63), and no information about early healthcare seeking (AOR = 4.88, 95% CI: 1.91–12.43) were identified; moreover, from the qualitative findings, mothers’ perceptions of the illness were mild, poor service provision, and economic problems were determinants of delay. Awareness, barriers, compliance, and perception emerged as themes.

Conclusion

The prevalence of delays in seeking healthcare for children with diarrhea was high. This poses a negative health risk to the lives of children and their caregivers. A large family size, poor knowledge about diarrhea danger signs, difficulty paying for treatment, and many others were factors associated with delayed health care seeking. Hence, the government and other concerned stakeholders should give due emphasis to tackling the identified causes of delay in seeking health care for children under five years of age with diarrhea by diverting community focus toward timely care seeking and disease prevention.

Introduction

A delay in seeking healthcare is defined as when parents or caregivers seek medical attention for a child’s illness more than 24 hour after the onset of symptoms or functional limitations [1]. Health-seeking behavior refers to the various actions individuals undertake to maintain, protect, or enhance their health, irrespective of their perceived health status [2]. This behavior includes recognizing an illness, determining when to seek medical care, selecting a healthcare provider, following treatment plans, and assessing the effectiveness of healthcare services [3].

To gain a deeper understanding of health-related behaviors, numerous theories and models have been established [4, 5]. Among these, Andersen’s health behavior model is frequently utilized to investigate the factors that influence healthcare-seeking behavior [6]. According to this model, predisposing, enabling, and need factors at both individual and community levels are crucial for fostering health-seeking behavior and the use of healthcare facilities.

Globally, many child fatalities are attributed to delays in seeking healthcare [7]. Approximately 70% of child deaths result from such delays [8]. A significant number of children die without ever accessing a health facility or due to delays in obtaining care, particularly in low-income countries [9].

In developing nations, most caregivers of children with diarrhea do not seek timely medical assistance. Specifically, in sub-Saharan Africa, the utilization of healthcare for diarrhea is notably low [10, 11]. A report by the U.S. Agency for International Development indicates that treatment-seeking rates in Eastern African countries vary between 14% and 72% [12]. The Ethiopia Demographic and Health Survey 2016 revealed that only 41% of children with diarrhea sought medical advice or treatment on the same day or the following day after symptom onset [13]. Several studies conducted in Ethiopia have shown that healthcare-seeking behavior (HCSB) among caregivers is low, with only a minority seeking treatment for their sick children under five years old from health facilities [14,15,16].

Key factors influencing HCSB include poor socioeconomic status, attitudes toward modern treatment, low literacy levels among parents, large family sizes, previous experiences with childhood illness and mortality, and perceptions regarding the severity of illness [17, 18] (Fig. 1).

Inadequate healthcare-seeking behavior heightens the risk of morbidity and mortality among children [19]. Consequently, the World Health Organization asserts that timely and appropriate care could potentially reduce child deaths by 20% [20].

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Similarly, the 2019 Mini Ethiopian Demographic and Health Survey (EDHS) emphasized that prompt medical attention is vital in decreasing child mortality rates [21]. In areas with limited healthcare access, urgent care-seeking is critical [22]. The Ethiopian government has implemented community case management and integrated management of childhood illness (IMCI) protocols to enhance caregivers’ abilities to manage illnesses in children under five and improve access to care. Health extension workers also provide curative services and promote health at the community level while striving to enhance the health-seeking behaviors of mothers and other caregivers dealing with common childhood illnesses [23]. As a result, the proportion of individuals seeking medical attention increased from 0.13 in 2000 to 0.44 in 2016 [23, 24] .

A comprehensive exploration of the factors influencing healthcare-seeking behavior is essential for improving health outcomes, promoting health equity, and designing effective public health interventions. By understanding the barriers and motivations that shape healthcare-seeking behavior, we can develop targeted strategies to address these challenges and foster a healthier population.

Despite the advancements in health-seeking behavior, there remains limited understanding of the general healthcare-seeking behaviors of caregivers regarding diarrheal diseases and associated factors, particularly within this study area. Therefore, this study aims to assess delays in seeking healthcare for diarrheal disease patients and to identify and explore the factors influencing these behaviors among caregivers of children under five years old at health centers of Northwest Ethiopia.

Method and materials

Study area and period

The study was conducted in health centers located in Bahir Dar city, which serves as the capital of the Amhara National Regional State and is situated 560 km from Addis Ababa, the capital city of Ethiopia. The estimated total population of Bahir Dar is 249,851, comprising 124,426 females and 125,425 males. Among this population, there are approximately 52,695 children under the age of five [25]. The city currently has 13 public health facilities, including 2 referral hospitals, 1 primary hospital, and 10 health centers offering primary healthcare services, such as Integrated Management of Neonatal and Child Illnesses (IMNCI). The study took place from May 5 to June 5, 2022.

Study design

A cross-sectional study with mixed-method approach (Convergent Parallel Design) was conducted among caregivers of under five children attending health centres in a city of Northwest Ethiopia.

Populations

All caregivers of under five children with diarrhea who sought health care at Bahir Dar city health centers were the source population, while all caregivers of under five children with diarrheal disease who were available during the data collection period were the study population.

Inclusion and exclusion criteria

All caregivers of under five children seeking healthcare services for any type of diarrheal disease and visiting under five pediatric/IMNCI clinics in Bahir Dar city health centers were included in our study, while caregivers of children with diarrhea who visited Bahir Dar city health centers for appointments or follow-up for diarrhea treatment were excluded from the study.

Sample size determination and sampling procedures

Sample size determination

The sample size was determined by using a single population proportion formula, considering the assumption of a 95% confidence interval, a 5% margin of error, and a 67.08% delay in healthcare-seeking behavior [26]. \({\rm{n}} = {(Z\alpha /2)^2}{p^1}(1 - p1)\,\)

(????)

Were.

n = sample size,

p1 = prevalence of delay in seeking healthcare.

d = margin of error 5%,

\(Z\alpha /2\) =critical value at 95% CI.

n =(1.96)2*(0.67)(0.33).=340.

(??.????)2

After adding a 10% nonresponse rate (34 participants), the total sample size was 374.

The sample size for the second specific objective was calculated as follows: assumptions of 95% CI, a power of 80%, and a ratio of unexposed to exposed = 1; 1% outcome in the exposed group (P1), and 1% outcome in the unexposed group (P2) [18]. The sample size calculated by using the independent variable was found to be low compared to the sample size calculated for the first specific objective. Therefore, the sample size for the study was 374.

Sampling procedure and technique

Bahir Dar city was the study area. Then, all ten health centers found in the city were included. The total sample size was proportionally allocated for each health center based on the total number of under five children with diarrhea per month reported in the same month of last year, which is 1197. The sampling interval was determined by dividing the expected number of diarrhea cases who come to the health centers within one month (1197) by the sample size (374), which provided a sampling interval of three. Every three caregivers who came to the health centers were interviewed. A systematic random sampling technique was used to select mothers of children younger than five years with diarrhea. K = N/n, K = 1197/374 = 2.84 ≈ 3.

The purposive sampling technique was used to select participants for the qualitative study. Caregivers of children with diarrheal diseases were specifically targeted, focusing on those who could provide detailed and insightful information. A total of 20 key informant caregivers were chosen, with 2 representatives from each health center. Information saturation was achieved by the 15th interviewee.

Dependent variable

Delay in care-seeking for diarrheal disease.

Independent variables

Child and parental socio-demographic characteristics

Sex of the child, age of the child, number of under-five children, birth interval, age of the mother/caregiver, place of residence, education of the mother, education of the father, occupation of the mother, marital status, family size, and mother’s knowledge about diarrhea danger signs.

Enabling factors

Cost of treatment, distance to the nearest health facility, preferred health facility, health insurance, and the person who first decided to take the child for medical treatment.

Disease-related factors

Type of diarrhea, previous history of diarrheal episodes, first response to child diarrhea, frequency of stools per day, symptoms of current diarrhea, reason for seeking medical care for children with diarrhea today, dehydration status.

Promptness of treatment-seeking for diarrhea in children

First time of care-seeking, and information about early treatment-seeking for diarrhea.

Operational definitions

The caregiver

Any person above 18 years of age who was directly responsible for the care of the child at the time of the study was included [19, 27].

Health Care seeking

Is any care sought from defined governmental or nongovernmental health facility for a child with diarrheal diseases [19].

Delays in seeking care

Care that was sought from health facilities after 24 h from the recognition of the presence of diarrhea in under five children [27].

Timely care-seeking

Care that was sought from health facilities within 24 h from the recognition of the presence of diarrhea in under-five children [27].

Diarrhea

If the caregivers explained that their unwell children had 3 or more loose or watery stools per day at any time [28].

Knowledge of diarrhea danger signs

In our study, caregivers were asked to mention diarrhea danger signs that warrant immediate care seeking from a health facility. The unprompted responses were measured against a list of five diarrhea danger signs on the questionnaire as stipulated by IMCI [29]. These include a child who has a sunken eyeball, is lethargic, is not able to drink/drinks too poorly, has a skin pinch that goes back very slowly, and is restless/irritable. A dichotomous variable was computed, and the caregivers’ knowledge was classified as good or poor in the following manner.

Good knowledge

Those mothers answered above the median of the knowledge questions [30].

Poor knowledge

Mothers who answered less than or equal to the median of the knowledge questions [30].

Data collection tools and data collection procedure

Quantitative data were collected using a structured interviewer-administered questionnaire and chart review, which was developed by reviewing different prior literature [21, 31, 32]. The questionnaire included child and maternal sociodemographic characteristics, enabling factors, need/disease factors, and prompt treatment-seeking. The questionnaire was prepared in English and then translated into the Amharic version. Finally, the questionnaire was translated back to English to check its consistency. An interview guide with probing questions [33] was used as a data collection tool for the qualitative part. The interview guide was initially prepared in English and then translated into Amharic to facilitate understanding for both the interviewer and interviewee. It included five main questions, supplemented by probing questions. Qualitative data were collected through in-depth interviews (IDIs) conducted in a quiet environment, free from noise and other distractions. The data collection began with broad, general questions, followed by more specific probing questions. During the interviews, participants were actively engaged; the interviewer listened attentively until the participant finished expressing their thoughts before asking follow-up questions based on their responses. All information was recorded through tape recordings and notes to ensure comprehensive documentation of the inquiries.

Data quality control

Quantitative data were confirmed by thorough determination and representative sample size. The use of proper data-gathering approaches, such as face-to-face interviews, was also assured. Furthermore, the quality of the data was assured through the use of a well-designed questionnaire. Four BSc. Nurses for data collection and one master of public health holder for supervision received one day of training on the questionnaire for common understanding. Before the study, a pretest was administered to 5% of the sample to ensure the consistency of the questionnaire and to make amendments. The data collection process was supervised by the supervisor throughout the data collection time. The investigators examined and checked the data collected each day for completeness and consistency. The validity of the qualitative data was assured via thorough, careful, and honest questioning and rapport-building with participants. Summary and reflection of participants’ narratives were carried out to verify the accuracy of the participants. The validity of the data was also ensured by using a carefully worded interview guide. Member checking was performed to check whether the transcribed document was in line with the participant’s idea and an audit trial was applied to keep all the recorded data in the hand of the researcher to cross-check again. In addition, the given codes and themes were checked by outside impartial unbiased reviewers. Coding and recoding were performed to assure dependability.

Data analysis and processing

The data were entered into Epi Data version 4.6 and exported to SPSS version 25 for analysis. For descriptive statistical analysis, the frequency distribution, median, and percentage were calculated. For categorical data, frequency distributions and percentage measurements were employed, whereas medians and interquartile ranges were used for numerical and continuous variables. The histogram and Shapiro Wilk test were used to check the distribution of a numerical or continuous variable. The median and interquartile ranges were used for the numerical or continuous variables, respectively for those variables not normally distributed. The associated factors were identified using bivariable and multivariable logistic regression. Chi-square and binary logistic regression assumptions were checked before performing logistic regression. With respect to the 95% CI in the bivariable logistic regression, variables with a p –value less than 0.25 were selected for multivariable logistic regression. Multicollinearity was checked between independent variables through the variance inflation factor(VIF) for continuous independent variables and Spearman’s rank correlation for categorical independent variables. The results of the multi-collinearity tests showed no problem with collinearity. The VIF was < 5 for each independent variable. The Hosmer-Lemeshow test was used to check the model’s goodness of fit, and its value was 0.37 for this study. Finally, a p value < 0.05 with a 95% CI was considered to indicate statistical significance in the multivariable logistic regression model. The qualitative data were analyzed in the following manner: At the end of each interview day, audio transcripts were written and reviewed by the authors. The authors transcribed the audio recordings and repeatedly read and reviewed the transcribed tapes to ensure the accuracy of the wording. The data were subsequently entered into open-code software version 4.03 and analyzed thematically. A step-by-step thematic analysis of the qualitative data was carried out. The authors first familiarized with the data by reading it several times. The data file was then shared with experts in qualitative data analysis, and substantial feedback was received. Initial codes were generated and organized after that (combined similar). Additionally, themes were generated and reviewed. These themes were then defined and assigned names. Finally, the analyzed information was documented. Interpretations, inferences, and themes were utilized to present the qualitative data effectively.

Results

Sociodemographic characteristics of the respondents and children

In this study, 374 mothers/caregivers who had under five years old children with diarrhea were interviewed with a response rate of 100%. The median age of the respondent was 30 years old with an interquartile range (IQR) of 25 to 34 years old. The majority of the respondents, 337(90.1%) were married. Regarding sex and age of the child, 53.5% of children were males and 52.7% of children were in the age group of < 24 months. The majority, 260(69.5%) of the respondents were urban residents (Table 1).

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Enabling factors

Among 374 caregivers, 261 (69.8%) homes were at a distance < 30 min from the preferred health facility on foot. Two hundred fifty-nine (69.3%) caregivers of under-five children with diarrhea utilized health insurance. More than half, 210(56.1%) of the caregivers responded that the cost of treatment at the health facility was easy. Because they are near, 184(20.55%) and they do not charge too much, 147(16%) mothers/caregivers were the major reasons for the selection of health facility (Table 2).

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Disease-related factors

Most of the participants 276 (73.8%) responded to the diarrhea of children by taking them to the health facility during the first episode.

About one hundred Ninety-nine (25.03%) of the caregivers took their children immediately when the diarrhea of children was increasing in frequency. However, only 70(9.27%) of caregivers reported that they seek immediate medical care for only diarrhea. Regarding the type of diarrhea, 303(81.0%) of mothers/caregivers of children complained of a watery type of diarrhea. The dehydration status of under-five children with diarrheal illness shows that 322(86.1%) and 52(13.9%) did not have dehydration and some dehydration respectively, but no an under-five child with severe dehydration among those who visited health facilities during study period (Table 3).

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Promptness of treatment-seeking

Among 374 Participants, one hundred seventy-four (46.5%) caregivers took their children immediately (within 24 h) after the onset of diarrhea illness. But, more than half, 200(53.5) of caregivers sought medical care after 24 h of the onset of diarrhea illness. Among the reasons for the delay in seeking health facilities care, 44(22%) of caregivers were not seeking care for their child due to the illness being mild and 42(21.0%) were due to perceived that the disease was resolved by itself over time. Most of the participants were getting information about the importance of early treatment for diarrhea 342 (91.4) (Table 4).

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The proportion of delays in seeking healthcare for diarrheal disease

From the total of 374 mothers seeking health care for a child with diarrhea diseases, 200 (53.48, 95% C.I: 48.4–58.5) were delayed in seeking healthcare (Fig. 2).

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Factors associated with delay in health institution care-seeking

Thirty-two potential variables were identified as contributing factors to delays in seeking healthcare for diarrheal diseases among mothers and caregivers of children under five. These variables were categorized into four groups: socio-demographic factors, enabling factors, need/disease-related factors, and promptness of treatment-seeking factors. In the bivariable logistic regression analysis, seventeen factors emerged as significant at P < 0.25. All these variables were subsequently included in the multivariable logistic regression model. The multivariable analysis revealed six statistically significant variables associated with delays in seeking care at health institutions: family size, maternal knowledge about danger signs, caregivers who did not initially visit health facilities for diarrhea, treatment costs, instances where diarrhea was the sole presenting symptom, and lack of information regarding the importance of early treatment (P < 0.05).

Specifically, mothers or caregivers with larger families (more than five members) were 2.64 times more likely (Adjusted Odds Ratio [AOR] = 2.64, 95% Confidence Interval [CI]: 1.26–5.43) to delay seeking care compared to those from smaller families (fewer than five members). Furthermore, caregivers with inadequate knowledge about danger signs were 3.25 times more likely (AOR = 3.25, 95% CI: 1.60–6.60) to experience delays compared to those with good knowledge. This sentiment was echoed in qualitative findings: “It would be better if health professionals provided health education about child health-related topics to raise awareness. Most of us lack information about child health care and issues; instead, we rely on neighbors and rumors” (29–36 years-old caregiver). Participants who reported that treatment costs were burdensome were 2.95 times more likely (AOR = 2.95, 95% CI: 1.61–5.38) to delay seeking care than those who found costs manageable. A 33-37years-old caregiver articulated this concern: “I prefer to stay at home due to the expenses associated with medical treatment, especially the fees at private clinics; managing all the costs for medical examinations and medications is very challenging. Therefore, I try to treat my child at home as much as possible until she recovers.” Another caregiver noted, “We may not have cash readily available, and it takes time to sell hens or cereals in the market, which can lead to delays of several days after the onset of symptoms” (34–41 years aged caregiver of a sick child). Mothers or caregivers who did not seek healthcare facilities as their first response to diarrhea were nearly four times more likely (AOR = 3.94, 95% CI: 1.96–7.93) to delay care compared to those who did visit a health facility initially. This finding was supported by a quote from a caregiver aged 26–34 years: “I will delay if the diarrhea seems naturally caused by a milk tooth; I check her mouth first and won’t go to a health institution because it cannot be treated with medicine if it’s due to a milk tooth. She added that she preferred home remedies like garlic for her child’s gum discomfort.” Participants whose children presented only with diarrhea were 2.39 times more likely (AOR = 2.39, 95% CI: 1.01–5.63) to delay seeking treatment compared to children exhibiting additional concerning symptoms such as bloody diarrhea or vomiting. Qualitative findings reinforced this point: “I decide based on symptoms; if there’s severe diarrhea mixed with blood and vomiting and my child appears weak, I will take her to the health center immediately” (Caregiver of child in her late 20s or early 30s). Conversely, another mother stated that if her child exhibited mild diarrhea without other symptoms, she would attempt home treatments first. Finally, caregivers lacking information about the importance of timely treatment for diarrhea faced nearly five times higher odds of delaying care compared to those who received such information (AOR = 4.88, 95% CI: 1.91–12.43)( Table 5). This was highlighted in qualitative feedback: “Health professionals should provide education on child health topics to improve awareness; many of us are unaware of proper child healthcare practices and rely on hearsay” (Caregiver of child aged between 29 and 38).

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Discussion

In this study, we found a prevalence of 53.48% for delayed healthcare seeking in cases of diarrheal disease. Additionally, we identified several contributing factors.

This prevalence aligns with a study conducted in Nairobi, which reported a similar rate of 55% [34], and a study in Zambia that indicated 48% [35]. However, these rates are lower than those reported in previous studies in Addis Ababa, which found a rate of 72.8% [15], and in Kenya, where the rate was 61.5% [36]. The observed differences may be attributed to variations in sample size, study design, or study setting. Conversely, the prevalence of delayed healthcare seeking in this study was higher than that reported in studies from the Arsi Zone of Ethiopia (45.7%) [14], India (30.9%) [37], and rural Uganda (24%) [11]. Potential reasons for these discrepancies include differences in study settings, periods, sample sizes, community support, and the dissemination of information at the community level.

The study also found that 73.8% of mothers sought medical care from a health facility during their child’s first episode of diarrhea. These findings are consistent with those from studies conducted in Mekelle (72.5%) and Northwest Ethiopia (77.7%) [8, 16], and Uganda (83%) [11]. In contrast, approximately 52% of diarrhea cases in Zambia were treated at home [35]. This variation may be due to differences in the sociodemographic characteristics of participants, sample sizes, and the presence of health package policies in Ethiopia, such as the expansion of health extension programs and coordinated maternal and child health services that include comprehensive health education packages [27].

The study indicated that caregivers with larger families (more than five members) were more likely to delay seeking medical care compared to those with smaller families. This finding is consistent with studies conducted in northwest Ethiopia [38], India [37], southern Malawi [39], and Bangladesh [40]. This trend may be attributed to the traditional role of women in Ethiopia as primary caregivers for their families, coupled with financial constraints associated with larger households seeking healthcare.

Mothers or caregivers who possessed limited knowledge about danger signs were three times more likely to delay seeking care compared to those with good knowledge. This finding is consistent with studies conducted in Iran [2] and Nigeria [39]. Increased awareness of danger signs and other disease symptoms can significantly influence health-seeking behavior by prompting individuals to seek care within the first 24 h of a diarrheal episode [11].

Furthermore, caregivers who did not visit a health facility as their first response to diarrhea were more likely to delay seeking care than those who did seek professional help initially. This finding aligns with studies conducted in Woliso (central Ethiopia), Arba Minch (southern Ethiopia), and Rwanda [1, 10, 23]. A possible explanation for this trend may involve the counseling provided by healthcare professionals during early visits.

Caregivers who took their children to health facilities when diarrhea was the only presenting symptom were 2.39 times more likely to delay seeking treatment compared to those whose children exhibited additional concerning symptoms (e.g., bloody diarrhea, vomiting, inability to feed or feed poorly, fever, sunken eyes, increased thirst, irritability or restlessness, and increased frequency of diarrhea). These findings are consistent with other studies conducted across Africa, Yemen, and the Cochrane Database of Systematic Reviews (2016) [29, 34, 41]. Qualitative results further support these findings by highlighting that serious signs and symptoms significantly influence care-seeking behavior for sick children. The serious signs and symptoms of the disease are important determinants of care-seeking behavior for a sick child [8].

Another notable finding from this study was that participants who reported difficulty affording treatment were three times more likely to delay seeking care compared to those who found treatment costs manageable. These results are consistent with a study conducted in Niger [42] but contradict findings from Arba Minch town, which indicated that treatment costs did not predict delays among mothers or caregivers of children under five with diarrheal illness [23]. This discrepancy may stem from socioeconomic differences and rising treatment costs.

Participants who lacked information on the importance of early healthcare-seeking were five times more likely to delay care-seeking than those who had received such information. A similar finding was reported in Ethiopia [43]. This suggests that increased awareness regarding the benefits of timely healthcare-seeking can significantly enhance prompt access to treatment for childhood diarrhea [36].

Additionally, the study identified several reasons cited by caregivers for not seeking treatment at health facilities despite delays. These included perceptions that the illness was mild (22%), beliefs that the disease would resolve on its own over time (21%), prior resolution of similar ailments without professional intervention (15%), treatment costs (15%), fears regarding immediate care availability (4.5%), reliance on traditional remedies at home (2%), purchasing medication from drug vendors (11%), and lack of time (5.5%). These reasons align with findings from a study conducted in Efratana Gidim District, East Amhara [44], and are further supported by qualitative results. Such limitations may be attributed to insufficient awareness regarding how to recognize danger signs associated with diarrhea severity and appropriate timing for seeking treatment. Furthermore, it is crucial to avoid trivializing diarrhea as an illness while also addressing treatment cost concerns comprehensively [45]. The lived experiences shared by mothers regarding delays in seeking healthcare highlight perceptions of illness severity as mild, economic challenges, and inadequate service provision as significant factors influencing their decisions.

Strength and limitation of the study

Strengths

The combination of both quantitative and qualitative study designs enhances the understanding of the study’s outcomes.

Limitations

Limited Scope of Healthcare Facilities: This research was confined to government-run healthcare institutions. This means that children who received treatment in private healthcare facilities were not included in the study. This limitation might introduce selection bias, as the characteristics of children treated in government facilities may differ from those treated in private facilities. Additionally, because this study utilized a cross-sectional design, the observed associations may not reflect temporal relationships and should not be interpreted as causal.

Conclusion and recommendation

The prevalence of delays in seeking healthcare for children with diarrhea is significant. This situation poses serious health risks to both the children and their caregivers. Factors contributing to these delays include large family size, inadequate knowledge about the danger signs of diarrhea, financial difficulties in affording treatment, and several others. Therefore, the government and other relevant stakeholders should prioritize addressing the identified causes of delayed healthcare seeking for children under five with diarrhea. This can be achieved by shifting community focus towards timely care seeking and disease prevention.

Data availability

Data is provided within the manuscript or supplementary information files.

Abbreviations

AOR:

Adjusted Odds Ratio

BSC:

Bachelor of Science

CI:

Confidence Interval

COR:

Crude Odds Ratio

DHS:

Demographic Health Survey

EDHS:

Ethiopia Demographic Health Survey

HC:

Health Centers

IMNCI:

Integrated Management of Newborn and Childhood Illness

IQR:

InterQuartile Range

LMICs:

Low- and Middle-Income Countries

MDGs:

Millennium Development Goals

NGOs:

Non-Governmental Organizations

ORT:

Oral Rehydration Therapy

ORS:

Oral Rehydration Solution

PI:

Principal Investigator

SSA:

South Asia and Sub-Saharan Africa

USA:

United States of America

VIF:

Variance Inflation Factor

WHO:

World Health Organization

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