An epidemiological study of health care seeking behaviour of under five children in Algeria: what lessons for improving the health care system?

In many developing countries, dissatisfaction with primary health care hats been accompanied by inappropriate use of university teaching hospitals, fr equently for benign health problems. This situation is often attributed to the user population who supposedly misunderstands the functioning of health systems. This article describes the health seeking process and outcome of consultations for under-five children in two geographic zones in Algeria (v ery different in their care networks, and in the socioeconomic and educatio nal characteristics of their populations), using a representative sample of users of public and private health services. During 4 one-week periods in 1991, a cross-sectional study was carried out among families of children an d the health personnel they consulted in all the health structures in the 2 zones. A Franco-Algerian supervisory team prepared consensual definitions of bath the seriousness and the urgency of the pathology, as well as of the appropriateness of the health care structure chosen for that condition. Th e analysis of 1560 consultations shows dysfunctions in the health seeking p rocess: numerous '"self-referrals" (94%); unjustified recourse to universit y hospitals in 29% of cases; important delays before consulting (greater th an or equal to 1 week in 14% of cases); absence of the mother during the co nsultation; differences in the mode of recourse according to the child's se x (for equivalent seriousness and urgency, recourse is more frequent to the emergency room and university hospital for bays, but girls are more often hospitalized). Nonetheless, the Algerian supervisors of the research consid er that the choice of the health care facility is appropriate in 91% of cas es. At the service level, dysfunctions are equally frequent, especially the absence of the transfer of information on the child between different heal th care professionals. The primary preoccupation of parents is with accessi bility (distance, cost), which leads to recommending the revitalizing of sm all first-line facilities, especially in rural areas, the more so because t hey are used and appreciated by families.