Prevalence of healthcare-seeking behavior among caregivers for common childhood illness in Ethiopia using PMA 2021–2023 data a multilevel analysis

Healthcare-seeking behavior refers to the actions taken by caregivers to seek medical care for illness. Globally, the failure to seek timely care for common childhood illnesses particularly diarrhea, fever, and cough remain a major contributor to under-five mortality. Timely health care-seeking behavior of caregivers plays a critical role in reducing preventable deaths. However, evidence on individual- and community-level factors influencing care-seeking remains limited in Ethiopia so this study aims to determine prevalence and factors associated with healthcare-seeking behavior for common childhood illness. A secondary data analysis was conducted using the Performance Monitoring for Action (PMA) Ethiopia 2021–2023 Cohort II survey. A total weighted sample of 826 caregivers of under-five children with fever, cough, or diarrhea included. Data preparation involved merging, cleaning, recoding, and management of missing data through multiple imputation, with five imputations and ten iterations, following Rubin’s rules for pooling estimates. Descriptive statistics were computed, and a multilevel logistic regression model was applied to account for the hierarchical structure of the data. Both individual- and community-level factors were examined, and variables with a p value < 0.05 were considered statistically significant. Of the 826 weighted caregivers the prevalence of health-seeking behavior among caregivers was 39.6% (95% CI 35.8–43.3%). Healthcare-seeking increased with the number of reported illnesses, ranging from 36.3% for one illness to 54.6% for three illnesses. In the final multivariable multilevel analysis, Mothers who received ANC from health extension workers were 46% less likely to seek care (AOR = 0.54; 95% CI 0.33–0.88), while those who delivered in a health facility were 1.64 times more likely (AOR = 1.64; 95% CI 1.01–2.69). Caregivers whose children had two illnesses were 3.40 times more likely to seek healthcare (95% CI 1.92–6.01), and those with three illnesses were 1.55 times more likely (95% CI 1.06–2.07). Caregivers from richer households had higher odds of seeking healthcare (AOR = 2.10; 95% CI 1.09–4.04). Health-seeking behavior for childhood illnesses in Ethiopia remains low, with fewer than two in five caregivers seeking healthcare. Both individual- and household-level factors were important determinants, highlighting the need to improve maternal health service utilization, strengthen health extension service quality, and address socioeconomic disparities.