Background Pneumonia continues to be the second leading cause of both morbidity and mortality in children under five years in Kenya. In part, the high burden of the disease arises from delay and inappropriate health-seeking by caregivers. Caregivers delay seeking care at health facilities due to the administration of home-based remedies. Some home remedies may lead to a prolonged hospital stay and, in many cases, result in death. However, little is known about the home-based care practices for pneumonia. This study sought to examine predictors of home-based care practices and pneumonia experiences that influence health-seeking behaviour in Endebess Sub-County, Kenya. Methods A cross-sectional study involving 273 caregivers accompanied by the qualitative study in the 24 health personnel was conducted from May to August, 2019. Questionnaires and key informant interview guides were used to collect data. Simple random sampling was used to select caregivers visiting the seven public health facilities in the sub-county. Quantitative data were analysed using SPSS Version 22 at a statistical significance of P≤ 0.05, whereas qualitative data were analysed by searching for emerging themes on home-based care practices and experiences shared by caregivers. Results Timely health-seeking behaviour was associated with available home care remedies (P=0.035) and knowledge of pneumonia symptoms (P<0.001). Caregivers with pneumonia experience from the house-hold (P<0.001; odds ratio, OR=5.73, 95% confidence interval, CI=2.787-11.799) and from other community members (P<0.001; OR=6.49, 95% CI=3.71-11.34) were more likely to visit the hospital on time relative to those without experience. Conclusions To improve health-seeking behaviour among caregivers, there is a need for health facility focal persons to incorporate health education and behaviour change communication interventions on pneumonia management at the community and hospital visits as caregivers seek antenatal and postnatal care services.

Background Pneumonia accounts for 16% of all child deaths in Kenya, and it is the second killer of children under the age of five. Pneumonia burden is attributed to inadequate access to healthcare and poor health-seeking by caregivers. Endebess caregivers report delays of 1-14 days and subject their children to medicine from shops before visiting a hospital, as evidenced by the history of the presenting illness in patient files. In addition, irrational prescription has been demonstrated regardless of clinical guidelines. This study explored health facility practices and drug prescription patterns that influence health-seeking behaviour in Endebess Sub-county, Kenya. Methods A cross-sectional study involving 273 caregivers accompanied by a qualitative study on 24 health personnel was conducted from May to August 2019. Using a simple random sampling technique, a questionnaire was administered to caregivers visiting the health facilities. Key informant interview guides were also conducted with health care personnel. Quantitative data were analysed using logistic regression, whereas qualitative data were analysed by searching for emerging themes on health facility practices and prescription patterns across health facilities. Results Overall, stratification by health facility practices revealed that there were numerous significant results at the level of P<0.001, including the availability of drugs, administration of a starting dose, type of drug prescribed, willingness to recommend the facility, place caregiver seeks treatment (P=0.005) and facility of choice (P=0.001), which all influenced willingness to revisit the hospital. In relation to health information, the significant results at the level of P<0.001 included adequate instructions, the confidence of the caregiver to give the correct dosage at home, satisfaction levels and shared decision making on choices of antibiotic therapy (P=0.005) were associated with a higher willingness to revisit the hospital. There was a varied pattern of prescriptions for antibiotics. Consistently the odds of willingness to revisit the hospital increased among caregivers who had an injection medication prescribed for their children (P=0.380; odds ratio, OR=2.06, 95% confidence interval, CI=0.41-10.42) relative to those on oral medication. Conclusions There is a need for strict control of prescribing antibiotics in children under five years. Shared decision making on the choice of therapy should not be limited to chronic illnesses.