Community and facility surveys illuminate the pathway to child survival in Liben Woreda, Ethiopia.

OBJECTIVES To apply "Pathway to Survival" analysis to baseline assessments to inform integrated management of childhood illness programmes. DESIGN A cross-sectional survey evaluating community-based knowledge, practices and coverage and health facility quality. SETTING Liben Woreda (population 122, 410), a district in Borana Zone, of Ethiopia's Oromia region, from August 1997-Febuary 1998. SUBJECTS Three hundred and sixty eight mother-child pairs (age < 24 months) seen in the community and 28 children (age < 5 years) in health facilities. RESULTS Of the 368 mothers interviewed 50% reported that their child was ill in the previous two weeks (184/368). Amongst the 101 mothers of children under the age of six months only 24% reported exclusive breast-feeding (24/101). There were 194 children who should have completed their immunisation schedule; only 17% of them had done so (33/194). Amongst the 111 children who had diarrhoea, only 17% had received home treatment with ORS (19/111). Thirty per cent of mothers of children with possible pneumonia (25/83) and 28% who reported malaria (14/50) sought appropriate care. Amongst those caregivers seen at the health facility only 26% had an understanding of treatment recommendations. CONCLUSIONS Based on the pathway to survival analysis, mother's knowledge of illness recognition is limited and they practice both home care and care seeking poorly. Thus few children are likely to receive and comply with standard case management.