Background of the study: Globally, about 75% of under-five deaths are still caused by febrile illnesses such as pneumonia, malaria, and typhoid fever. In Kenya, more than 10 million episodes of acute febrile illness are treated annually among under-five-children. According to the Kenya Demographic and Health Survey, during the two weeks before the survey, 2% of children under age 5 showed symptoms of an ARI, 17% exhibited fever, and 14% experienced diarrhea. Therefore, this study ascertained the proportion and determinants of health-seeking behavior (HSB) for febrile illness and generated information that informs the efforts towards timely seeking care for febrile illness among caregivers under under-five.

Objective: To determine the proportion and the determinants of health-seeking behavior (HSB) for febrile illness among caregivers of children under five years in Butula Sub- County, Busia County, Kenya.

Methods and Materials: The study was conducted in Busia County using a cross-sectional design, which utilized a mixed method approach. The study population was caregivers for the under five years old children in the Butula sub-county. The participants were selected using systematic random sampling with the guide from Butula sub-county register. Quantitative data was to be gathered from caregivers using questionnaires, and data from health facility staff (key informants) and community health volunteers (focus group discussion) was used for qualitative data. Qualitative data was transcribed, entered, coded, and analyzed thematically. For quantitative data, categorical variables were analyzed using frequencies, percentages, and mean and standard deviations in Statistical Package for Social Scientists (SPSS). To test association, chi-squire was used while multivariable analysis was done using binominal regression with a p < 0.05 as statistically significant at a 95% confidence level.

Results: The quantitative data was gathered from 271 caregivers, while qualitative data was obtained from two focused groups, each involving five community health volunteers and interviews from 6 key informants. A majority of the participants were aged between 21-30 years (42.1%, n = 114), were females (84.1%, n = 228), had secondary education (44.6%, n = 121), were farmers by occupation (39.9%, n = 108), earned less than KES. 5000 (75.3%, n = 204), were from nuclear households (79.3%, n = 215), and had at most two children at home (48.7%, n = 132). The proportion of children under five years old with febrile illness was 64.6% (n = 175), with 70.1% (n = 190) of the participants indicating they sought care for a child's fever within 24 hours. Individual factors influencing good health-seeking behavior 24 hours after controlling confounders were unemployment (adjusted odds ratio (aOR) = 0.49, 95% CI: 0.217 – 0.593, p = 0.018), preferring self-medication over profession care (aOR = 0.14, 95% CI: 0.054 – 0.363, p < 0.001), had two or more children (aOR = 0.63, 95% CI: 0.425 – 0.937, p = 0.042), and being confident in identifying fever (aOR = 7.0, 95% CI: 2.200 – 22.439, p = 0.001). The health system-related factors with statistically significant association to health-seeking behavior were caregivers who felt a facility was far (aOR = 0.86, 95% CI: 0.526 – 0.914, p = 0.027), those who received health education from the staffs' olds (aOR = 1.8, 95%CI: 1.201-4.122, p=0.015), and the level of facility (aOR = 4.4, 95% CI: 2.015 – 9.750, p < 0.001). Qualitatively, patient ignorance, stock-outs, facility distance, staff workload, and poverty among caregivers were identified as factors influencing health-seeking behavior.

Conclusion: In our study, many caregivers take more than 24 hours to seek care for fever. Among the identified individual factors associated with health-seeking behavior were unemployment, those who preferred self-medication for their child's fever, having two or more children, and being comfortable identifying fever in children under five. The health system factors that were identified to have a negative impact on health-seeking behavior within 24 hours were a facility being too far, staff workload, drug stock out, and inadequate sensitization due to a shortage of community outreach programs.

A semi-structured interviewer-administered questionnaire containing five parts was developed. At least two research assistants were recruited to administer the questionnaires to the mother and help fill them out. The research assistants then face-to-face interviewed the caregivers guided by the questionnaire.The quantitative data was manually entered into Statistical Package for Social Scientists (SPSS) version 25, whereby descriptive analysis was done. The descriptive statistics, frequency, proportion, and measures of central tendency, like mode, were analyzed and illustrated in tables, figures, and graphs. Inferential statistical analysis included using the chi-square test of the association to measure levels of association between independent variables.