Barriers to accessing and using primary and secondary healthcare among children under-five in the Koutiala health district of Mali

Barriers to accessing care in Koutiala encompass issues with the healthcare delivery system (e.g., stock shortages, service fees, referral failure, distances to CSComs), patterns of service utilization (e.g., self-medication, traditional medicine) and sociocultural factors (e.g., household decision-making). The low referral completion rate is particularly concerning, as these children are high-risk for health deterioration and death and require urgent care. This may partially explain the elevated under-five mortality rate observed in the community.