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- Title
Determinants of Care Seeking for Children With Pneumonia and Diarrhea in Guatemala: Implications for Intervention Strategies.
- Authors
Bruce, Nigel; Pope, Daniel; Arana, Byron; Shiels, Christopher; Romero, Carolina; Klein, Robert; Stanistreet, Debbi
- Abstract
Objectives. We identified barriers to care seeking for pneumonia and diarrhea among rural Guatemalan children. Methods. A population-based survey was conducted twice from 2008 to 2009 among 1605 households with children younger than 5 years. A 14-day calendar recorded episodes of carer-reported pneumonia (n = 364) and diarrhea (n = 481), and formal (health services, public, private) and informal (neighbors, traditional, local shops, pharmacies) care seeking. Results. Formal care was sought for nearly half of severe pneumonias but only for 27% within 2 days of onset, with 31% and 18%, respectively, for severe diarrhea. In multivariable analysis, factors independently associated with formal care seeking were knowing the Community Emergency Plan, mother's perception of illness severity, recognition of World Health Organization danger signs, distance from the health center, and having someone to care for family in an emergency. Conclusions. Proximal factors associated with recognizing need for care were important in determining formal care, and were strongly linked to social determinants. In addition to specific action by the health system with an enhanced community health worker role, a systems approach can help ensure barriers are addressed among poorer and more remote homes.
- Subjects
GUATEMALA; CHILD care; CONFIDENCE intervals; DIARRHEA; EPIDEMIOLOGY; HEALTH services accessibility; HELP-seeking behavior; INTERVIEWING; MEDICAL care use; MOTHERS; MULTIVARIATE analysis; PNEUMONIA; POPULATION geography; RESEARCH funding; RURAL population; TIME; LOGISTIC regression analysis; DATA analysis; REPEATED measures design; CROSS-sectional method; SEVERITY of illness index; HEALTH literacy; HEALTH &; social status; DESCRIPTIVE statistics; SYMPTOMS; CHILDREN
- Publication
American Journal of Public Health, 2014, Vol 104, Issue 4, p647
- ISSN
0090-0036
- Publication type
Article
- DOI
10.2105/AJPH.2013.301658