An epidemiological study of gender issues in health care seeking behaviourand care of under five children, in developing countries

Since the end of the 1970's, excess mortality among girls, from the end of the neonatal period until the age of 4 years, has been observed in some Sou th Asian countries. Explanatory hypotheses for this situation have in fact noted differences by sex in food allocation and in care during illness. In some North African and sub-Saharan countries in Africa, mortality data sugg est the same type of phenomenon, but less reliable statistics and a lack of data analysis by sex on use of health services does not really allow clari fication of the problem. The objective of this study was to analyse health seeking behaviour by sex and to identify explanatory factors for any differ ences found. A cross sectional study of 1560 consultations of under-5 child ren was carried out in 6 university and regional hospitals in 3 African cou ntries: Algeria (the zones of Ain Taya and Tigzirt); Togo (the zones of Lom e Atakpame' and Kara) and the Congo (Brazzaville). Results confirm the exis tence of discrimination against girls. In ways which vary according to zone s, and in comparison to boys, observations of girls show: underrepresentati on among outpatients (29% in Tigzirt, 40% in Kara), especially when they ha ve many siblings, of which some are sisters; longer duration of the develop ment of symptoms before first resort (leading to increased severity of symp toms); less investment in health care; detrimental feeding practices. Highe r SES of the father plays a favourable role, especially for girls, and chil dren of both sexes benefit when the mother has a good educational level. Th e large regional differences demonstrate the complex interaction among expl anatory factors: rurality, problems of access to the hospital, low economic level, low social status of women. This research opens the way so that, in Africa, research will no longer be carried out on health seeking behaviour and utilisation of health services without examining separately the situat ion of boys and girls, and analysing the possible causes of any differences .