title: Health care seeking for childhood diarrhea in developing countries: evidence from seven sites in Africa and Asia.
abstract: We performed serial Health Care Utilization and Attitudes Surveys (HUASs) among caretakers of children ages 0-59 months randomly selected from demographically defined populations participating in the Global Enteric Multicenter Study (GEMS), a case-control study of moderate-to-severe diarrhea (MSD) in seven developing countries. The surveys aimed to estimate the proportion of children with MSD who would present to sentinel health centers (SHCs) where GEMS case recruitment would occur and provide a basis for adjusting disease incidence rates to include cases not seen at the SHCs. The proportion of children at each site reported to have had an incident episode of MSD during the 7 days preceding the survey ranged from 0.7% to 4.4% for infants (0-11 months of age), from 0.4% to 4.7% for toddlers (12-23 months of age), and from 0.3% to 2.4% for preschoolers (24-59 months of age). The proportion of MSD episodes at each site taken to an SHC within 7 days of diarrhea onset was 15-56%, 17-64%, and 7-33% in the three age strata, respectively. High cost of care and insufficient knowledge about danger signs were associated with lack of any care-seeking outside the home. Most children were not offered recommended fluids and continuing feeds at home. We have shown the utility of serial HUASs as a tool for optimizing operational and methodological issues related to the performance of a large case-control study and deriving population-based incidence rates of MSD. Moreover, the surveys suggest key targets for educational interventions that might improve the outcome of diarrheal diseases in low-resource settings.
authors: Dilruba
authors: D
authors: Nasrin
authors: Yukun
authors: Y
authors: Wu
authors: William C
authors: WC
authors: Blackwelder
authors: Tamer H
authors: TH
authors: Farag
authors: Debasish
authors: D
authors: Saha
authors: Samba O
authors: SO
authors: Sow
authors: Pedro L
authors: PL
authors: Alonso
authors: Robert F
authors: RF
authors: Breiman
authors: Dipika
authors: D
authors: Sur
authors: Abu S G
authors: ASG
authors: Faruque
authors: Anita K M
authors: AKM
authors: Zaidi
authors: Kousick
authors: K
authors: Biswas
authors: Anna Maria
authors: AM
authors: Van Eijk
authors: Damian G
authors: DG
authors: Walker
authors: Myron M
authors: MM
authors: Levine
authors: Karen L
authors: KL
authors: Kotloff
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D016022:Case-Control Studies; D002675:Child, Preschool; D003906:Developing Countries; D003968:Diarrhea, Infantile / Q000191:economics / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D005202:Asia, Eastern / Q000453:epidemiology; D005260:Female; D005440:Fluid Therapy; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012720:Severity of Illness Index
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