title: Health care utilization during terminal child illness in squatter settlements of Karachi.
abstract: OBJECTIVE
  Information on health seeking behavior and health care utilization has important policy implications in health systems development. The paper presents some of the issues related to health care utilization and health seeking behavior in case of terminal child illness in seven squatter settlements of Karachi.
  
  
  METHODS
  From seven squatter settlements of Karachi, with a population of 100,000 approximately, we collected information, using pretested structured questionnaire, from the mothers on health care utilization during the final illness of under five children dying during 1995-1996. These deaths were identified from an earlier baseline health and demographic survey in these areas.
  
  
  RESULTS
  Interviews were completed for 259 infant and child deaths of which 57% were boys. Of all deaths 72% were taken to a health care provider, of which 82% went as soon as the child got ill. Private sector is the most preferred first choice i.e., 83%. Of all those who had been to a health care provider, 65% were referred to some other place and 72% of them took more than 12 hours altogether to reach the referred facility. Children in older age categories (OR 4.4 95% CI 2.22-8.67 and OR 5.0, 95% CI 2.09-12.31), boys (OR 2.6, 95% CI 1.46-4.77) and those with appropriate or incomplete immunization (OR 4.1, 95% CI 2.13-7.94) were significantly associated with the health care utilization as compared to their counterparts.
  
  
  CONCLUSIONS
  Living in urban areas does not ensure accessibility to effective health care. In poor urban communities, referral to other facility delay the initiation of effective treatment in case of child illness leading to death which could be prevented otherwise. Private sector constitutes an important segment of our health care system, which requires strengthening and back up support. Furthermore, the study finding is suggestive of gender discrimination in health seeking behavior.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi.
authors.forename: I J
authors.initials: IJ
authors.lastname: Hasan
authors.forename: A
authors.initials: A
authors.lastname: Khanum
mesh_terms: D017677:Age Distribution; D002675:Child, Preschool; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D010154:Pakistan / Q000453:epidemiology; D011204:Poverty Areas; D012017:Referral and Consultation; D017678:Sex Distribution; D019452:Terminally Ill / Q000706:statistics & numerical data*