title: Caregiver recognition of childhood diarrhea, care seeking behaviors and home treatment practices in rural Burkina Faso: a cross-sectional survey.
abstract: BACKGROUND
  To design effective national diarrhea control programs, including oral rehydration solution (ORS) and therapeutic zinc supplementation, information is needed on local perceptions of illness, external care seeking behaviors, and home treatment practices.
  
  
  METHODS
  A cross-sectional, community-based household survey was conducted in the Orodara Health District, Burkina Faso. Caregivers of 10,490 children <27 months were interviewed to assess child diarrhea prevalence and related care practices. Characteristics of households, caregivers, children, and reported illnesses were compared for those caregivers who did or did not recognize the presence of diarrhea, as defined according to clinical criteria (≥ 3 liquid or semi-liquid stools/day). Multiple logistic regression models were used to examine factors associated with illness recognition and treatment.
  
  
  RESULTS
  Clinically defined diarrhea was present in 7.6% (95% CI: 7.1-8.1%) of children during the 24 hours preceding the survey but recognized by only 55% of caregivers. Over half (55%) of the caregivers of 1,067 children with a clinically defined diarrhea episode in the past 14 days sought care outside the home; 78% of those seeking care attended a public sector clinic. Care was sought and treatment provided more frequently for children with fever, vomiting, anorexia, longer illness duration, and those living closer to the health center; and care was sought more frequently for male children. 80% of children with recent diarrhea received some form of treatment; only 24% received ORS, whereas 14% received antibiotics. Zinc was not yet available in the study area.
  
  
  CONCLUSIONS
  Caregivers frequently fail to recognize children's diarrhea, especially among younger infants and when illness signs are less severe. Treatment practices do not correspond with international recommendations in most cases, even when caregivers consult with formal health services. Child caregivers need additional assistance to recognize diarrhea correctly, and both caregivers and health care providers need updated training on current diarrhea treatment recommendations.
authors.affiliation: Department of Nutrition, University of California Davis, Davis, California, United States of America.
authors.forename: Shelby E
authors.initials: SE
authors.lastname: Wilson
authors.forename: Césaire T
authors.initials: CT
authors.lastname: Ouédraogo
authors.forename: Lea
authors.initials: L
authors.lastname: Prince
authors.forename: Amadou
authors.initials: A
authors.lastname: Ouédraogo
authors.forename: Sonja Y
authors.initials: SY
authors.lastname: Hess
authors.forename: Noël
authors.initials: N
authors.lastname: Rouamba
authors.forename: Jean Bosco
authors.initials: JB
authors.lastname: Ouédraogo
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Vosti
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Brown
mesh_terms: D002050:Burkina Faso / Q000453:epidemiology; D017028:Caregivers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D005191:Family Characteristics; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D019035:Rural Health Services; D012680:Sensitivity and Specificity; D015032:Zinc / Q000627:therapeutic use
chemical_list: D015032:Zinc