Mother's educational level and children's illness severity in the emergency unit of Joseph-Raseta-Befelatanana Hospital. What kind of implications?

The parents educational conditions are one of the factors of health inequalities among children. During May 2009 the parents instruction level of children admitted at the triage unit of a Pediatric Service in Antananarivo Madagascar was evaluated and related to the severity of their children health status and to the mode of reference. All the surviving children (from 2 months to 15 years old) were included in this study. Patients were classified by the IMCI guideline and we analyzed the educational level of their mothers. Each patient was classified as severe illness or without severe illness according to IMCI algorithm. The quality of referring physician was recorded: public physicians liberal physicians nurses or without referral. Among 296 children 9 (3%) died before admission 217 (75.6%) were included. Among them 123 (56.7%) had a severe illness and 382% general signs of danger. The severity (92.3 versus 54.4%; P = 0.003) the number of severe dehydration (15.4 versus 3.9%; P = 0027) and malnutrition (15.4 versus 4.4%; P = 0.039) were related with a poor parents educational level. The referral agents were mostly liberal physicians (56.7%) public physicians (26.7%) or nurses (1.8%). Mothers with higher educational level preferred to attend liberal physicians (58 versus 41.9%; P = 0.1). The reference delay was shorter if there was a severe illness (6.41 versus 19.6 days; P 0.000). Despite the fact that access to hospital care was respectful of a two-step process (85.3%) the number of patients with severe illness was high among families with low educational level. Theses results suggest to educate in priority the mother with low education in order to recognize the general signs of danger and facilitate early first health care.