Health care utilization for diarrhea and fever in 4 urban slums in Karachi.
OBJECTIVE
To estimate the fraction of fever and diarrhea patients making use of private practitioners, self-treatment, hospital care, drug vendors, community health centers and traditional healers.


METHODS
A cross-sectional survey.


METHODS
Four slums in and around Karachi during October and November, 2001.


METHODS
A sample of 1842 households was selected with probability proportional to size of the slum. The household head or a representative was asked regarding the treatment providers for diarrhea and cases of fever persistent for 3 days or more. Only households with an actual case of fever and/or diarrhea were included in the analysis.


RESULTS
The study found that more than half of diarrhea and fever cases are seen by private practitioners. Self medication with medicines available in the home or specifically purchased for the disease episode from a drug vendor combined provides 13% to 18% of health care. Only between 11% and 13% of patients are seen by the public sector, hospitals and community health centers. There was no significant difference between the choice of health care provider for diarrhea and fever cases.


CONCLUSIONS
In this survey, the majority of fever and diarrhea patients presented first to private practitioners and not to drug vendors or the public sector. Successful passive surveillance of febrile or diarrheal illness in these communities has to integrate private practitioners.
Zaidi
S Shujaat H
SS
Department of Paediatrics, The Aga Khan University, Karachi, Pakistan.
Seidlein
Lorenz Von
LV
Nizami
S Q
SQ
Acosta
Camilo
C
Bhutta
Zulfiqar A
ZA
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003968:Diarrhea, Infantile / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D011203:Poverty; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D014504:Urban Health