Increasing childhood illnesses (diarrhea and fever) and decreasing care-seeking practices in Nepal: Insights from three most recent Demographic and Health Surveys (2011, 2016 and 2022)

Nepal has notably reduced major childhood illnesses like diarrhea and acute respiratory infections via community-based child health programs. This study analyzes trends and factors influencing the prevalence of fever and diarrhea in children under five, along with care-seeking behaviors, using data from the Nepal Demographic and Health Surveys of 2011, 2016, and 2022. Between 2011 and 2022, fever prevalence increased from 19% to 23%, while care-seeking for diarrhea and fever declined slightly (diarrhea: 62% to 57%; fever: 80% to 78%). Care-seeking at private health facilities increased for both illnesses (diarrhea: 37% to 42%; fever: 54% to 67%). Key determinants varied by condition and region. Diarrhea prevalence was lower in children aged 36-59 months but higher in Bagmati and Karnali provinces and in Hill and Terai regions. Care-seeking for diarrhea was less likely for first-born children and more likely in Lumbini province and among children of native Maithili-speaking mothers. Fever prevalence was higher among children aged six months to four years, those born to native Nepali-speaking mothers, and second-born children. Care-seeking for fever was lower in children of mothers facing multiple disadvantages but higher in Madhesh province. Care at private health facilities for fever was more common among children with fewer maternal disadvantages, living in urban areas, from Lumbini or Madhesh provinces, or with native Maithili-speaking mothers. The increasing prevalence of childhood illnesses combined with decreasing care-seeking practices underscores a major public health challenge. Most caregivers/mothers opting for private health facilities suggests trust or access issues with public services and government facilities. Programs should focus on recruiting health care providers with good understanding of local languages and cultures, focus on province-specific health challenges, and enhance health communication in local languages, especially in the Terai region, to reduce the burden of childhood illnesses and improve care-seeking practices in Nepal.