Caregiver dynamics and factors affecting health-seeking behaviors for childhood diarrhea in Mukuru informal settlements in Nairobi, Kenya

Background: Diarrheal disease is the third leading cause of morbidity and mortality in children under 5 years globally. Approximately 1.7 billion diarrheal cases are reported annually resulting in more than 400,000 deaths in children under five. Sub-Saharan Africa still harbors populations with the highest global mortality rates for diarrhea accounting for approximately 60% of all diarrheal deaths in this age group. In Kenya, diarrhea significantly contributes to child mortality, with around 16,000 deaths annually among children under five, particularly affecting those living in urban informal settlements where access to clean water and sanitation is often limited. This study sought to investigate the determinants of healthcare-seeking practices among caregivers of children under 5 years with diarrhea in Mukuru informal settlement in Nairobi County. 

Methods: This study employed a cross-sectional design to investigate healthcare-seeking behaviors among caregivers of children under 5 years with diarrhea. Between September 2023 and January 2025, we conducted focused group discussions among 90 caregivers of children identified through purposive sampling. In addition, using a structured questionnaire, we interviewed 374 caregivers at the Mother and Child Health (MCH) clinics at three health facilities, targeting those who brought healthy children for immunization. Qualitative data were analyzed thematically using NVivo while bivariate and multivariate analysis was performed on the quantitative data. 

Results: Caregivers with secondary education had lower odds of seeking care compared to those with only primary education (AOR = 0.171, 95% CI: [0.060-0.488], p = 0.001). Additionally, caregivers who perceived that poor human fecal disposal causes diarrhea had significantly higher odds of seeking healthcare (AOR = 3.259, 95% CI: [1.185-8.965], p = 0.022). Trust in clinicians also played a role, with those who strongly agreed about the importance of clinicians in treating diarrhea having higher odds of seeking care (AOR = 0.259, 95% CI: [0.028-2.374], p = 0.050). 

Conclusion: This study demonstrates that specific socio-demographic factors, particularly education level and perceptions of disease causation, significantly influence health-seeking behaviors among caregivers of children under five with diarrhea in Mukuru informal settlement. Caregivers with secondary education were less likely to seek care, while those aware of the link between poor sanitation and diarrhea showed increased healthcare-seeking behavior. Additionally, trust in healthcare providers was identified as a crucial factor affecting care-seeking decisions.