title: Healthcare-seeking behaviour of primary caregivers for acute otitis media in children aged 6 months to <30 months in Panama: results of a cross-sectional survey.
abstract: Acute otitis media (AOM) is the most common bacterial childhood infection. However, caregivers with children having mild episodes often do not seek healthcare services, which may lead to an under-appreciation of the disease experienced by the community. The objectives of this survey were to estimate the proportion of primary caregivers who went to a healthcare facility when they suspected that their child aged 6 to <30 months was having an AOM episode during the past 6 months and to assess what factors influenced their decision.
  
  
  
  This observational, cross-sectional survey of primary caregivers (≥18 years), with at least one child aged 6 to <30 months was performed in 19 healthcare facilities in Panama (March to May 2013). A 28-item paper questionnaire was administered to assess demographic data, AOM symptoms, as well as potential healthcare-seeking behaviour and factors influencing this behaviour. Potential confounding effects were individually assessed using Chi-squared or Cochran-Mantel-Haenszel tests, and all together in logistic regression models.
  
  
  
  The total number of eligible participants was 1330 (mean age 28.5 ± 8.0 years). Of these, 245 participants had at least one child whom they suspected had an AOM episode during the past 6 months. Of the 245 participants, 213 (86.9%) sought healthcare at a facility. Several factors were associated with healthcare usage: perceived severity of illness (p = 0.001), occupational status of the caregiver (p = 0.002), household income (p = 0.016) and length of time since the last suspected AOM episode (p = 0.032).
  
  
  
  When confronted with a child with obvious symptoms of AOM, the majority of caregivers reported seeking healthcare. This behaviour appeared to be associated with factors related to the severity of the illness, the length of time since the last episode, as well as with the income and occupational status of the caregivers themselves. As many episodes of AOM present with non-specific respiratory symptoms, our results apply only to caregivers who were confronted with children with an obvious symptom.
authors.affiliation: Cromsource for GSK, Avenue Fleming 20, W23 B2-183, 1300, Wavre, Belgium. ikaukiel@gmail.com.
authors.forename: Iris
authors.initials: I
authors.lastname: Villarreal
authors.affiliation: Caja de Seguro Social de Panamá, La Chorrera, 507, Panama City, Panama.
authors.forename: Rosario
authors.initials: R
authors.lastname: Turner
authors.affiliation: Quintiles Real-world & Late Phase Research, 201 Broadway, Cambridge, MA, 02139, USA.
authors.forename: Hyejin
authors.initials: H
authors.lastname: Jo
authors.affiliation: Quintiles Real-world & Late Phase Research, 201 Broadway, Cambridge, MA, 02139, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Park
authors.affiliation: Quintiles Real-world & Late Phase Research, 1801 Rockville Pike, Rockville, MD, 20852, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Gemmen
authors.affiliation: GSK, Avenue Fleming 20, 1300, Wavre, Belgium.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Pirçon
authors.affiliation: GSK, City of Knowledge, 230 BLDG, Panama City, Panama.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Castrejon
authors.affiliation: GSK, Avenue Fleming 20, 1300, Wavre, Belgium.
authors.forename: William P
authors.initials: WP
authors.lastname: Hausdorff
mesh_terms: D000208:Acute Disease; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000453:epidemiology / Q000628:therapy*; D010176:Panama / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014505:Urban Population
keywords: Acute otitis media; Caregivers’ behaviour; Childhood; Ear infection; Healthcare facility; Healthcare utilization; Severity of illness; Survey