Few studies have been done to assess socioeconomic inequities in health in African
countries. We sought evidence of inequities in health care by sex and socioeconomic
status for young children living in a poor rural area of southern Tanzania.
In a baseline household survey in Tanzania early in the implementation phase of integrated
management of childhood illness (IMCI), we included cluster samples of 2006 children
younger than 5 years in four rural districts. Questions focused on the extent to which
carers' knowledge of illness, care-seeking outside the home, and care in health facilities
were consistent with IMCI guidelines and messages. We used principal components analysis
to develop a relative index of household socioeconomic status, with weighted scores
of information on income sources, education of the household head, and household assets.
1026 (52%) of 1968 children reported having been ill in the 2 weeks before the survey.
Carers of 415 (41%) of 1014 of these children had sought care first from an appropriate
provider. 71 (26%) carers from families in the wealthiest quintile knew > or =2 danger
signs compared with 48 (20%) of those from the poorest (p=0.03 for linear trend across
quintiles) and wealthier families were more likely to bring their sick children to
a health facility (p=0.02). Their children were more likely than poorer children to
have received antimalarials, and antibiotics for pneumonia (p=0.0001 and 0.0048, respectively).
Care-seeking behaviour is worse in poorer than in relatively rich families, even within
a rural society that might easily be assumed to be uniformly poor.