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- Title
Predictors of diarrheal mortality and patterns of caregiver health seeking behavior in in Karachi, Pakistan.
- Authors
Qamar, Farah Naz; Zaman, Umber; Quadri, Farheen; Khan, Asia; Shaikh, Babar Tasneem; Azam, Iqbal; Nasrin, Dilruba; Kotloff, Karen; Levine, Myron; Brown, Nick; Zaidi, Anita K M
- Abstract
<bold>Background: </bold>Pakistan is unfortunately among the five countries that contributed to the most deaths due to diarrhea and pneumonia in 2010. To explore factors associated with diarrheal deaths we assessed care-seeking behavior and other predictors of diarrhea-related mortality in children in selected low-income peri-urban communities of Karachi, Pakistan.<bold>Methods: </bold>A mixed methods study (qualitative and quantitative) using matched case-control design and focus group discussions with parents of children with moderate to severe diarrhea (MSD) was undertaken. Cases were children <5 years of age who died within 60 days of developing an episode of MSD. Controls were age-matched children who survived after 60 days of an episode of MSD. Demographic, clinical, and care-related behavioral predictors of mortality were assessed. Conditional logistic regression was performed, matched adjusted odds ratios (mOR) are reported.<bold>Results: </bold>Parents of 77 cases and 154 controls were interviewed. Cases were less likely to receive appropriate care compared to controls (mOR = 0.2, 95% confidence interval (CI) 0.05-0.91). Refusal for hospital admission (OR = 8.9, 95% CI 2.6-30.8), and delays in reaching the health facility (OR = 3.6, 95% CI 1.0-12.9) were significant independent predictors of mortality. We found strong beliefs in traditional and spiritual healing in the population; use of both modern and traditional/spiritual treatments concurrently was common.<bold>Conclusion: </bold>Appropriate care seeking behavior predicts survival in children with diarrhea in Pakistan. There is a complex belief system relating to traditional and standard therapies. Health education for appropriate health care seeking should be implemented in order to achieve a substantial decline in diarrheal disease mortality in Pakistan.
- Subjects
PAKISTAN; CAREGIVERS; CULTURE; DIARRHEA; FOCUS groups; HEALTH behavior; HEALTH facilities; HEALTH services accessibility; HOSPITAL care; PARENTS; POVERTY; RESEARCH funding; CITY dwellers; LOGISTIC regression analysis; BURDEN of care; CASE-control method; PATIENTS' attitudes; ODDS ratio
- Publication
Journal of Global Health, 2016, Vol 6, Issue 2, p020406
- ISSN
2047-2978
- Publication type
journal article
- DOI
10.7189/jogh.06.020406