title: Determinants of care seeking for children with pneumonia and diarrhea in Guatemala: implications for intervention strategies.
abstract: OBJECTIVE
  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.
authors: Nigel Bruce, Daniel Pope, Christopher Shiels, and Debbi Stanistreet are with the Department of Public Health and Policy, University of Liverpool, Liverpool, UK. At the time of the study, Byron Arana, Carolina Romero, and Robert Klein were with the Center for Health Studies, University del Valle, Guatemala City, Guatemala.
authors: Nigel
authors: N
authors: Bruce
authors: Daniel
authors: D
authors: Pope
authors: Byron
authors: B
authors: Arana
authors: Christopher
authors: C
authors: Shiels
authors: Carolina
authors: C
authors: Romero
authors: Robert
authors: R
authors: Klein
authors: Debbi
authors: D
authors: Stanistreet
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003625:Data Collection; D003967:Diarrhea / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011014:Pneumonia / Q000453:epidemiology / Q000628:therapy*; D012424:Rural Population / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012959:Socioeconomic Factors