Insights into health care seeking behaviour for children in communities in KwaZulu-Natal, South Africa.

Background: South African infant and child mortality remains high, with many deaths occurring outside the formal health services. Delayed health care seeking represents a large proportion of these deaths.

Aim: To generate knowledge about the role of, and influences on, caregivers with regard to decision-making about when and where to seek care for sick children.

Setting: Two communities in KwaZulu-Natal.

Methods: A qualitative, exploratory design employing participatory research techniques was used to undertake focus group discussions with community members.

Results: Health care seeking for a sick child was described as a complex process influenced by multiple carers using multiple providers. Decision-making about seeking health care for a sick child was not an individual effort, but was shared with others in the household and guided by how the symptoms were perceived, either a Western illness or African illness. A sick child could either be treated at home or be taken to a variety of places including clinics, private doctors, traditional healers, faith healers and hospitals. Traditional healers were associated with the treatment of illnesses perceived to be traditional. Few participants said that they would take their child back to the original health provider if the child remained ill, but would move from one provider to another until the child's health improved.

Conclusion: The formal health system needs to ensure that sick children are identified and managed appropriately to reduce child deaths. Knowledge and understanding of health care seeking behaviour for sick children by carers is an important aspect. Interventions need to be designed with these contextual issues in mind.