An epidemiological study of health care seeking behaviour of under five children in hospital emergency rooms in Togo

The functioning and efficacy of pediatric emergency services are currently being questioned in many Northern countries, as well as in the South, for e xample in North Africa. Reference is often made to unjustified medical emer gencies in the face of an influx of patients with benign problems who come from socially disadvantaged families. In the university and regional hospit als in three regions in Togo, we compared three categories of under-5 patie nts: children sent to "day-time" emergency services after triage done by he alth personnel; those sent to the "ordinary consultation "; and children br ought after hours by their family (without referral by a health professiona l in 92% of cases) and seen in the "after-hours" emergency service. Serious tropical pathology (cerebral malaria, malaria, sickle cell disease) is mai nly seen in emergency consultations, in which high hospitalization rates ar e noted (83% during the day, 67% at night) and a lethality of 3.4%. One can not therefore use terms such as "false emergencies", "felt" and "medically unjustified" and the pediatric supervisor for the research considered that recourse to after-hours emergency services was justified in 75% of cases. F amilies using night services have higher educational levels than those sent to day emergency services, the mother's educational level being the main f actor associated with certain characteristics of health seeking behavior (d uration of symptoms prior to arrival at hospital, recourse to modern medica l drugs). There is often a long delay before recourse to hospital: only 45% of children seen after hours and half of those who died came the 1(st) or 2(nd) day of the illness. Self-medication at home is usual but recourse to tradipractitioners appears rare (4%). Several solutions can be envisaged an d should be linked: strengthening of the first level of care, technical imp rovements in emergency services, training of tradipractitioners in the reco gnition and referral of emergency cases, improvement of reception practices at the hospital level, prophylactic and preventive measures for tropical d iseases.