{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T23:07:29Z","timestamp":1775171249269,"version":"3.50.1"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Childhood illnesses, such as acute respiratory illness, fever, and diarrhoea, continue to be public health problems in low-income countries. Detecting spatial variations of common childhood illnesses and service utilisation is essential for identifying inequities and call for targeted actions. This study aimed to assess the geographical distribution and associated factors for common childhood illnesses and service utilisation across Ethiopia based on the 2016 Demographic and Health Survey.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The sample was selected using a two-stage stratified sampling process. A total of 10,417 children under five years were included in this analysis. We linked data on their common illnesses during the last two weeks and healthcare utilisation were linked to Global Positioning System (GPS) information of their local area. The spatial data were created in ArcGIS10.1 for each study cluster. We applied a spatial autocorrelation model with Moran\u2019s index to determine the spatial clustering of the prevalence of childhood illnesses and healthcare utilisation. Ordinary Least Square (OLS) analysis was done to assess the association between selected explanatory variables and sick child health services utilisation. Hot and cold spot clusters for high or low utilisation were identified using Getis-Ord Gi*. Kriging interpolation was done to predict sick child healthcare utilisation in areas where study samples were not drawn. All statistical analyses were performed using Excel, STATA, and ArcGIS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Overall, 23% (95CI: 21, 25) of children under five years had some illness during the last two weeks before the survey. Of these, 38% (95%CI: 34, 41) sought care from an appropriate provider. Illnesses and service utilisation were not randomly distributed across the country with a Moran\u2019s index 0.111, Z-score 6.22, P&lt;0.001, and Moran\u2019s index = 0.0804, Z-score 4.498, P&lt; 0.001, respectively. Wealth and reported distance to health facilities were associated with service utilisation. Prevalence of common childhood illnesses was higher in the North, while service utilisation was more likely to be on a low level in the Eastern, South-western, and the Northern parts of the country.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our study provided evidence of geographic clustering of common childhood illnesses and health service utilisation when the child was sick. Areas with low service utilisation for childhood illnesses need priority, including actions to counteract barriers such as poverty and long distances to services.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0281606","type":"journal-article","created":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T18:33:14Z","timestamp":1678473194000},"page":"e0281606","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Spatial distribution of common childhood illnesses, healthcare utilisation and associated factors in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health Survey"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9435-2135","authenticated-orcid":true,"given":"Atkure","family":"Defar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yemisrach","family":"B. Okwaraji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zemene","family":"Tigabu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars \u00c5ke","family":"Persson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kassahun","family":"Alemu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,3,10]]},"reference":[{"issue":"10129","key":"pone.0281606.ref001","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1016\/S0140-6736(18)30104-1","article-title":"Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health","volume":"391","author":"T Boerma","year":"2018","journal-title":"Lancet"},{"key":"pone.0281606.ref002","article-title":"Levels & Trends in Child Mortality: Report 2017, Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation\u2019, United Nations Children\u2019s Fund, New York","author":"United Nations Inter-agency Group for Child Mortality Estimation (UN IGME).","year":"2017"},{"key":"pone.0281606.ref003","article-title":"Ethiopia Demographic and Health Survey, 2011","author":"Central Statistical Agency and ICF International","year":"2011"},{"key":"pone.0281606.ref004","first-page":"1","article-title":"Jochen Rudolph MM. Diarrhoea prevalence in children under five years of age.pdf","volume":"7","author":"Katharina Diouf","year":"2014","journal-title":"Glob Health Action"},{"issue":"3","key":"pone.0281606.ref005","doi-asserted-by":"crossref","first-page":"150","DOI":"10.11648\/j.sjph.20140203.12","article-title":"Prevalence of pneumonia among under- five children in Este town and the surrounding rural kebeles, Northwest Ethiopia; A community based cross sectional study","volume":"2","author":"GA Fekadu","year":"2014","journal-title":"Sci J Public Heal"},{"key":"pone.0281606.ref006","unstructured":"UNICEF. UN IGME Child mortality report 2020 [Internet]. 2020. 52 p. Available from: https:\/\/www.unicef.org\/media\/60561\/file\/UN-IGME-child-mortality-report-2019.pdf."},{"key":"pone.0281606.ref007","unstructured":"Central Statistical Agency (CSA) [Ethiopis], ICF. Ethiopia Demographic and Health Survey 2016. 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