The suffered from common childhood illness 5.

The Human behavior is the internal coordinating replies to an internal and external stimulus 1. Human health is complete physical, mental and social well-being not merely the absence of disease 2, 3. Health care seeking behavior is defined as any action taken by someone to find an appropriate remedy after the child has a health problem 4. Around 6.3 million children aged under five died worldwide, in which most of them could be prevented with simple and inexpensive interventions 5. Childhood illnesses are the main health problems globally predominantly in Asian and African subcontinents 6. Under-five children are the most vulnerable group of the population suffered from common childhood illness 5.

The global under-5 mortality was 41 per 1000 live births 5 and in Ethiopia, the under-5 mortality was 67 deaths per 1,000 live births 7.The child is a victim of nutrition, socioeconomic and health factors, which causes malnutrition 8. A high number of child deaths occur all over the world especially in san Saharan Africa is attributed to the delay of proper care seeking in modern health facilities 9, 10.

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Poverty and lack of education are the major factors associated with under-five mortality in Ethiopia. Moreover, Advice or treatment in a health facility was required for 31% of children with ARI, 35% of children with fever, and 44% of children with diarrhea 7.The World Health Organization estimates that appropriate seeking of health care could reduce child mortality and morbidity by 20% 11.

Health -seeking behaviors is a function of not only the accessibility of health facilities and other sources of healthcare but also inspiration and capacity of individuals to seek medical treatment 12.Even though the common childhood illnesses are manageable successfully if timely recognized, facilitation of modern care seeking behavior remained a challenge today 13. A large number of children die without ever reaching a health facility and due to delays in seeking care 10.

Therefore, appropriate care seeking behavior is an important parenting instrument in preventing the child from preventable morbidity and moralities 14. To meet the Sustainable Development Goal (SDG) target one on under-five mortality by 2030 in reducing the number of under-5 deaths by 10 million between 2017 and 2030 6, a rapid improvement is needed to raise the community awareness in modern health-seeking behavior.Although Ethiopia has improvement on universal access to standard management of common childhood illnesses, healthcare-seeking behaviors of caregivers for child illness has remained low. Generally, there are some studies on health-seeking behavior in our countries but there is no study conducted to identify modern health-seeking behavior and associated factors in this study area.

Therefore the purpose of this study is to assess modern health-seeking behaviors and associated factors among mothers having under five children in Shire town, Northwest Tigray, Ethiopia.Main text A community-based, cross-sectional study design was used from March to April 2018 in the Shire town Northwest zone of Tigray, Ethiopia, located 1087 kilometers from Addis Ababa, the capital city of Ethiopia and 309 kilometers from Mekelle, the capital city of Tigray. The study employed a single population proportion sample size determination formula taking the magnitude of health-seeking behavior 72.7% from previous studies conducted in Bahir dar 15, 5% marginal error (d) with 95% confidence. The required final sample size with the design effect of 1.5 and 10% non-response rate was 504. Multi-stage sampling technique was employed to select 504 study participants. Three Kebels were selected by simple random sampling technique and to get the sample size from every three Kebels proportional allocation to sample size was done.

Systematic sampling technique (K=16) was used to choose the household for an interview and the starting mother was selected using a lottery method. Data was collected using a pretested interview administered structured questionnaire by three BSc degree holder nurses. The tools were adapted from different kinds of literature 13, 15-17 then modified and contextualized to fit the local situation and research objective.

Modern Healthcare seeking behavior: Activities that are taken by mothers who sought care for their children who have a health problem in the formal health care institutions (government health facilities, private hospitals/clinics) 2 Caregiver: The responsible individuals who taking care of a child either the relatives of the child or the mother13 Training and orientation were given for data collectors. The questionnaire was initially prepared in English and then translated into Tigrigna version (local language) by different experts of both languages to check its consistency. The questionnaire was pre-tested on five percent of the sample size in Aksum town. The collected data were reviewed and checked for completeness and consistency by the supervisor and principal investigator on a daily base. The data were coded, entered, cleaned edited using EPIDATA version 3.

1, and then exported to SPSS Version 22.0 for analysis. Binary logistic regression analysis was employed to look at the statistical association between the outcome variable and every single independent variable. Variables which showed statistical significance during bivariate analysis at ? 20% (p-value ?0.

20) were entered into multivariate logistic regression to isolate an independent effect of the predictors by using the backward elimination method. The Hosmer-Lemenshow test was used to check the appropriateness of the model for analysis. Results were presented using tables and texts. Adjusted odds ratios (AOR) with 95% CI, were estimated to assess the strength of associations and statistical significance was declared at a p-value