{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:32:43Z","timestamp":1792801963256,"version":"4.5.0"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T00:00:00Z","timestamp":1715817600000},"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>Despite the decrease in the global under-five mortality rate, the highest rates of mortality are reported in sub-Saharan Africa. More than one-third of all deaths among under-five children are either from lower respiratory tract infections, diarrhea, or malaria. Poor treatment-seeking behavior for fever among mothers of under-five children is a big concern in sub-Saharan Africa. However, the pooled prevalence of prompt treatment of fever and its associated factors among under-five children in the region using nationally representative data is not known. Therefore, the findings of this study will inform policymakers and program managers who work on child health to design interventions to improve the timely and appropriate treatment of fever among under-five children.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data from the recent demographic and health surveys of 36 countries in sub-Saharan Africa conducted between 2006 and 2022 were used. A total weighted sample of 71,503 living children aged under five years with a fever was included in the study. Data extracted from DHS data sets were cleaned, recorded, and analyzed using STATA\/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value &lt;0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The pooled prevalence of prompt treatment of fever among under-five children in sub-Saharan African countries was 26.11% (95% CI: 25.79%, 26.44%). Factors like maternal education [AOR = 1.18; 95% CI (1.13, 1.25)], maternal working status [AOR = 1.34; 95% CI (1.27, 1.41)], media exposure [AOR = 1.05; 95% CI (1.01, 1.10)], household wealth index [AOR = 1.13; 95% CI (1.06, 1.19)], distance to a health facility [AOR = 1.18; 95% CI (1.13, 1.23)], healthcare decisions [AOR = 1.34; 95% CI (1.01, 1.77)], visited healthcare facility last 12 months [AOR = 1.45; 95% CI (1.38, 1.52)], antenatal care attendance [AOR = 1.79; 95% CI (1.61, 1.99)], place of delivery [AOR = 1.55; 95% CI (1.47, 1.63)], and community-level antenatal care utilization [AOR = 1.08; 95% CI (1.02,1.14)] were significantly associated with prompt treatment of fever among under-five children.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The pooled prevalence of prompt treatment of fever among under-five children in sub-Saharan African countries was low. Educated women, working mothers, having media exposure, rich household wealth status, perceiving distance to a health facility was not a big problem, making healthcare decisions with husband or partner, visiting healthcare facility in the last 12 months, antenatal care attendance, health facility delivery, and high community-level antenatal care utilization increase the odds of prompt treatment of fever. Therefore, women\u2019s empowerment, information dissemination through mass media, maintaining regular visits to healthcare facilities, and strengthening health facility delivery and antenatal care services are strongly recommended.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0303680","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T17:34:28Z","timestamp":1715880868000},"page":"e0303680","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Prompt treatment of fever and its associated factors among under-five children in sub-Saharan Africa: A multilevel analysis of evidence from 36 countries"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9316-245X","authenticated-orcid":true,"given":"Enyew Getaneh","family":"Mekonen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belayneh Shetie","family":"Workneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadesse Tarik","family":"Tamir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alebachew Ferede","family":"Zegeye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,16]]},"reference":[{"key":"pone.0303680.ref001","unstructured":"Child mortality (under 5 years). World Health organization, 28 January 2022."},{"key":"pone.0303680.ref002","unstructured":"DISEASE CONTROL PRIORITIES. Third ed. Reproductive, Maternal, Newborn, and Child Health, ed. R.N. Dean T. Jamison, Hellen Gelband, Susan Horton, Prabhat Jha, Ramanan Laxminarayan, Charles N. Mock. Vol. 2. 2016: The World Bank."},{"key":"pone.0303680.ref003","unstructured":"Institute for Health Metrics and Evaluation (IHME). GBD compare data visualization. 2018."},{"key":"pone.0303680.ref004","unstructured":"Children: improving survival and well-being. World Health Organization, 2020."},{"key":"pone.0303680.ref005","unstructured":"National Institute for Health and Care Excellence. Feverish Illness in Children: Assessment and Initial Management in Children Younger than 5 Years. Clinical guideline No. 160. NICE, London, 2013."},{"key":"pone.0303680.ref006","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1186\/s12879-023-08350-5","article-title":"Ba, Factors associated with pediatric febrile illnesses in 27 countries of Sub\u2011Saharan Africa","volume":"23","author":"V.M.C Paddy Ssentongo","year":"2023","journal-title":"BMC Infectious Diseases"},{"issue":"2","key":"pone.0303680.ref007","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1111\/j.1365-2648.2006.03802.x","article-title":"Management of childhood fever by parents: literature review","volume":"54","author":"E.H. Walsh AM","year":"2006","journal-title":"Journal of Advanced Nursing"},{"key":"pone.0303680.ref008","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1136\/bmj.39218.495255.AE","article-title":"Assessment and initial management of feverish illness in children younger than 5 years: summary of NICE guidance","volume":"334","author":"M, L.M. Richardson","year":"2007","journal-title":"BMJ"},{"key":"pone.0303680.ref009","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/S1473-3099(19)30572-9","article-title":"Antibiotic exposure among children younger than 5 years in low-income and middle-income countries: a cross-sectional study of nationally representative facility-based and household-based surveys","volume":"20","author":"D.A.V. Fink G","year":"2020","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"pone.0303680.ref010","doi-asserted-by":"crossref","first-page":"107","DOI":"10.7883\/yoken.JJID.2009.107","article-title":"Febrile illnesses of different etiology among outpatients in four health centers in Northwestern Ethiopia","volume":"62","author":"A. Animut","year":"2009","journal-title":"Japanese Journal of Infectious Diseases"},{"key":"pone.0303680.ref011","first-page":"260","article-title":"Quality of care for under-fives in first-level health facilities in one district of Bangladesh","volume":"83","author":"S.E. Arifeen","year":"2005","journal-title":"Bulletin of the World Health Organization"},{"issue":"10061","key":"pone.0303680.ref012","doi-asserted-by":"crossref","first-page":"2811","DOI":"10.1016\/S0140-6736(16)00738-8","article-title":"Reproductive, maternal, newborn, and child health: key messages from disease control priorities 3rd edition","volume":"388","author":"R.E. Black","year":"2016","journal-title":"The Lancet"},{"issue":"6","key":"pone.0303680.ref013","doi-asserted-by":"crossref","first-page":"e0269844","DOI":"10.1371\/journal.pone.0269844","article-title":"Factors associated with delay in treatment-seeking behaviour for fever cases among caregivers of under-five children in India: Evidence from the National Family Health Survey-4, 2015\u201316","volume":"17","author":"D. Debsarma","year":"2022","journal-title":"Plos one"},{"key":"pone.0303680.ref014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1475-2875-13-348","article-title":"Determinants of delay in care seeking among children under five with fever in Dodoma region, central Tanzania: a cross-sectional study","volume":"13","author":"T. Kassile","year":"2014","journal-title":"Malaria journal"},{"issue":"12","key":"pone.0303680.ref015","doi-asserted-by":"crossref","first-page":"e0295772","DOI":"10.1371\/journal.pone.0295772","article-title":"Delays in seeking treatment for fever in children under five years of age in Nigeria: Evidence from the National Demographic Health Survey","volume":"18","author":"A.E. Anyasodor","year":"2023","journal-title":"Plos one"},{"key":"pone.0303680.ref016","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1093\/clinids\/10.1.168","article-title":"New concepts on the pathogenesis of fever","volume":"10","author":"D. Ca","year":"1988","journal-title":"Rev Infect Dis"},{"issue":"30","key":"pone.0303680.ref017","doi-asserted-by":"crossref","DOI":"10.7748\/ns2014.03.28.30.49.e8410","article-title":"Fever and feverish illness in children under five years","volume":"28","author":"P. McDougall","year":"2014","journal-title":"Nursing Standard"},{"issue":"1","key":"pone.0303680.ref018","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-016-3460-8","article-title":"Treatment-seeking behaviour for childhood fever among caretakers of Chivuna and Magoye rural communities of Mazabuka District, Zambia: a longitudinal study","volume":"16","author":"B.M. Hamooya","year":"2016","journal-title":"BMC public health"},{"issue":"2","key":"pone.0303680.ref019","doi-asserted-by":"crossref","first-page":"121","DOI":"10.55320\/mjz.50.2.398","article-title":"The Prevalence and Factors Associated with Prompt Diagnosis and Treatment of Fever among Under-five Children in Zambia; Evidence from a Country-wide Cross-Sectional Survey","volume":"50","author":"M. Nawa","year":"2023","journal-title":"Medical Journal of Zambia"},{"issue":"1","key":"pone.0303680.ref020","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1475-2875-8-219","article-title":"Socio-cultural predictors of health-seeking behaviour for febrile under-five children in Mwanza-Neno district, Malawi","volume":"8","author":"A.I. Chibwana","year":"2009","journal-title":"Malaria journal"},{"issue":"6","key":"pone.0303680.ref021","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1093\/ije\/dys184","article-title":"Demographic and health surveys: a profile","volume":"41","author":"D.J. Corsi","year":"2012","journal-title":"International journal of epidemiology"},{"key":"pone.0303680.ref022","article-title":"Cluster optimal sample size for demographic and health surveys","author":"A. Aliaga","year":"2006","journal-title":"7th International Conference on Teaching Statistics\u2013ICOTS"},{"key":"pone.0303680.ref023","unstructured":"Croft, T., et al., Guide to DHS Statistics: DHS-7 (version 2). Rockville, MD: ICF, 2020."},{"issue":"11","key":"pone.0303680.ref024","doi-asserted-by":"crossref","first-page":"e0295289","DOI":"10.1371\/journal.pone.0295289","article-title":"Home delivery among women who had optimal ANC follow-up in Sub-Saharan Africa: A multilevel analysis","volume":"18","author":"A.F. Zegeye","year":"2023","journal-title":"Plos one"},{"key":"pone.0303680.ref025","doi-asserted-by":"crossref","first-page":"203","DOI":"10.5334\/irsp.90","article-title":"Keep calm and learn multilevel logistic modeling: a simplified three-step procedure using Stata, R, mplus, and SPSS","volume":"30","author":"N. Sommet","year":"2017","journal-title":"International Review of Social Psychology"},{"issue":"3","key":"pone.0303680.ref026","doi-asserted-by":"crossref","first-page":"e0173578","DOI":"10.1371\/journal.pone.0173578","article-title":"Contextual factors associated with health care service utilization for children with acute childhood illnesses in Nigeria","volume":"12","author":"S.T. Adedokun","year":"2017","journal-title":"PLoS One"},{"issue":"1","key":"pone.0303680.ref027","first-page":"990","article-title":"Healthcare-seeking behaviors of mothers regarding their children in a tribal community of Gujarat, India","volume":"7","author":"H. Chandwani","year":"2015","journal-title":"Electronic physician"},{"issue":"1","key":"pone.0303680.ref028","article-title":"Health care seeking behavior of mothers for common childhood illness and associated factors in Woldia town administration, Northeast Ethiopia","volume":"10","author":"D. Demelash","year":"2020","journal-title":"Fam Med Med Sci Res"},{"issue":"8","key":"pone.0303680.ref029","doi-asserted-by":"crossref","first-page":"e0254885","DOI":"10.1371\/journal.pone.0254885","article-title":"Factors associated with healthcare seeking for childhood illnesses among mothers of children under five in Chad","volume":"16","author":"E. Budu","year":"2021","journal-title":"Plos one"},{"issue":"1","key":"pone.0303680.ref030","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1146\/annurev.pu.10.050189.001145","article-title":"The role of media across four levels of health promotion intervention","volume":"10","author":"J.A. Flora","year":"1989","journal-title":"Annual review of public health"},{"issue":"1","key":"pone.0303680.ref031","doi-asserted-by":"crossref","first-page":"92","DOI":"10.7196\/SAJCH.2016.v10i1.1076","article-title":"An analysis of national data on care-seeking behaviour by parents of children with suspected pneumonia in Nigeria","volume":"10","author":"M.B. Abdulkadir","year":"2016","journal-title":"South African Journal of Child Health"},{"issue":"1","key":"pone.0303680.ref032","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-019-2439-8","article-title":"Men\u2019s roles in care seeking for maternal and newborn health: a qualitative study applying the three delays model to male involvement in Morogoro Region, Tanzania","volume":"19","author":"J.A. Greenspan","year":"2019","journal-title":"BMC Pregnancy and Childbirth"},{"issue":"1","key":"pone.0303680.ref033","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s41256-022-00270-2","article-title":"Factors associated with mothers\u2019 health care-seeking behaviours for childhood fever in Burkina Faso: findings from repeated cross-sectional household surveys","volume":"7","author":"H. Badolo","year":"2022","journal-title":"Global Health Research and Policy"},{"issue":"1","key":"pone.0303680.ref034","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-020-05683-8","article-title":"Factors influencing mothers\u2019 health care seeking behaviour for their children: evidence from 31 countries in sub-Saharan Africa","volume":"20","author":"S.T. Adedokun","year":"2020","journal-title":"BMC health services research"},{"issue":"11","key":"pone.0303680.ref035","doi-asserted-by":"crossref","first-page":"e017122","DOI":"10.1136\/bmjopen-2017-017122","article-title":"Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries","volume":"7","author":"J. Kuhnt","year":"2017","journal-title":"BMJ open"},{"issue":"3","key":"pone.0303680.ref036","doi-asserted-by":"crossref","first-page":"e0264707","DOI":"10.1371\/journal.pone.0264707","article-title":"Individual and community-level factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia: A multilevel analysis","volume":"17","author":"B. Liyew","year":"2022","journal-title":"Plos one"},{"issue":"9","key":"pone.0303680.ref037","doi-asserted-by":"crossref","first-page":"e0273901","DOI":"10.1371\/journal.pone.0273901","article-title":"Determinants of care-seeking behaviour for fever, acute respiratory infection and diarrhoea among children under five in Nigeria","volume":"17","author":"I.G. Adeoti","year":"2022","journal-title":"Plos one"},{"issue":"4","key":"pone.0303680.ref038","doi-asserted-by":"crossref","DOI":"10.4314\/ejhs.v28i4.13","article-title":"Parents\u2019 knowledge of danger signs and health seeking behavior in newborn and young infant illness in Tiro Afeta district, Southwest Ethiopia: a community-based study","volume":"28","author":"M. Berhane","year":"2018","journal-title":"Ethiopian Journal of health sciences"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0303680","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T17:34:57Z","timestamp":1715880897000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0303680"}},"subtitle":[],"editor":[{"given":"Kahsu","family":"Gebrekidan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,5,16]]},"references-count":38,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0303680","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,16]]}}}