Factors associated with malaria care seeking among children under 5 years of age in Mozambique: a secondary analysis of the 2018 Malaria Indicator Survey

BACKGROUND: Mozambique is ranked fourth in a list of the 29 countries that accounted for 95% of all malaria cases globally in 2019. The aim of this study was to identify factors associated with care seeking for fever, to determine the association between knowledge about malaria and care seeking and to describe the main reasons for not seeking care among children under five years of age in Mozambique. METHODS: This is a quantitative, observational study based on a secondary data analysis of the 2018 Malaria Indicator Survey. This weighted analysis was based on data reported by surveyed mothers or caregivers of children aged 0-59 months who had fever in the two weeks prior to the survey. RESULTS: Care was reportedly sought for 69.1% [95% CI 63.5-74.2] of children aged 0-59 months old with fever. Care-seeking was significantly higher among younger children, < 6 months old (AOR = 2.47 [95% CI 1.14-5.31]), 6-11 months old (AOR = 1.75 [95% CI 1.01-3.04]) and 12-23 months old (AOR = 1.85 [95% CI 1.19-2.89]), as compared with older children (48-59 months old). In adjusted analysis, mothers from the middle (AOR = 1.66 [95% CI 0.18-3.37]) and richest (AOR = 3.46 [95% CI 1.26-9.49]) wealth quintiles were more likely to report having sought care for their febrile children than mothers from the poorest wealth quintile. Additionally, mothers with secondary or higher education level were more likely to seek care (AOR = 2.16 [95% CI 1.19-3.93]) than mothers with no education. There was no association between maternal malaria knowledge or reported exposure to malaria messages and care-seeking behaviours. The main reasons reported for not seeking care included distance to health facility (46.3% of respondents), the perception that the fever was not severe (22.4%) and the perception that treatment was not available at the health facility (15%). CONCLUSION: Health facility access and socioeconomic barriers continue to be important constraints to malaria service utilization in Mozambique.