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Shrestha et al BMC Public Health (2022) 22:1948 https://doi.org/10.1186/s12889-022-14318-y BMC Public Health Open Access RESEARCH Determinants affecting utilisation of health services and treatment for children under-5 in rural Nepali health centres: a cross-sectional study Binod Shrestha1, Dan J. Green2*, Manish Baidya1, Tim Chater3, Jiban Karki1,4, Andrew CK Lee5, Seema Khadka1, Gerda Pohl1, Rudra Neupane1 and Simon Rushton6 Abstract Background Large inequalities in child health remain in Nepal, with caste, ethnicity and sex being major determinants of deprivation and negative outcomes The purpose of this study was to explore whether key demographics of under 5s were associated with health seeking behaviours, utilisation of health care, and treatment received Methods Data came from Integrated Management of Neonatal & Childhood Illness (IMNCI) records of 23 health centres across five districts After digitising the paper records, the data was analysed by district, caste/ethnicity, sex, and age to investigate differences in the time taken to present at a health facility after the onset of symptoms of ARI, diarrhoea and fever; accuracy of diagnosis for pneumonia; and whether the correct treatment was prescribed for pneumonia as per IMNCI guidelines Results From 116 register books spanning 23 health centres, 30,730 child patient records were considered for analysis The median age of attendance was 18 months (Inter-Quartile Range = 10, 32), while were more male children that attended (55.7% vs 44.3% for females) There were statistically significant differences for the time taken to attend a health centre between different districts for ARI, diarrhoea and fever, with children in the remote Humla and Mugu districts taking significantly longer to present at a health facility after the onset of symptoms (all p