title: Do Social Factors Predict Appropriate Treatment of Child Diarrheal Disease in Peru?
abstract: Objectives Diarrheal disease is a significant cause of morbidity among children in Peru. Oral rehydration therapy (ORT) is a cost-effective evidence-based approach to treat diarrhea in young children, yet many Peruvian children in poorer households do not receive this life-saving treatment. This study investigates the social determinants of care-seeking behavior and utilization of appropriate home treatment for diarrheal episodes. Methods We used the nationally-representative 2008 Peru Demographic and Health Survey to: (1) describe the burden of non-bloody diarrheal disease among children <5 years old; and (2) identify socioeconomic correlates of care-seeking behavior and utilization/appropriateness of treatment among mothers of children with recent non-bloody diarrheal episodes (N = 1365). For the former, we reported descriptive statistics; for the latter, we utilized logistic regression to generate odds ratios. Results 2-week period prevalence of diarrheal disease was almost twice as high among poor (17 %) compared with wealthier (10 %) children, higher among children aged 12-23 months old (22 %), and higher among children from households that do not have an improved source of drinking water (16 %) compared with those that have an improved source (12 %). Interestingly, rural residence was a significant predictor of seeking care for diarrhea. Furthermore, although widely available, few mothers (15 %) used appropriate treatment for a recent diarrheal episode. Water source, mother's education, and wealth were significant predictors of appropriate home treatment. Conclusions Mothers in rural areas-typically with less access to care-were more likely to seek care for diarrheal disease in their children, even when adjusting for other variables. However, this increase in care seeking behavior did not extend to appropriate home treatment. Innovative behavior change strategies to reduce barriers to access and appropriate home treatment for diarrheal disease are important, especially given effective and affordable treatment strategies. Future studies should elucidate specific barriers to seeking and utilizing ORT and other appropriate home treatments.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. kate.volpicelli@gmail.com.
authors.forename: Kathryn
authors.identifier: 0000-0002-3146-1331
authors.initials: K
authors.lastname: Volpicelli
authors.affiliation: School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Buttenheim
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003469:Culture; D003967:Diarrhea / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009035:Mothers / Q000193:education / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D012424:Rural Population; D012959:Socioeconomic Factors
keywords: Child health; Demographic Health Survey (DHS); Diarrhea; Infectious disease; Malnutrition; Peru; Prevalence