Health Care Utilization and Attitude Surveys Associated with the Global Enteric Multicenter Study (GEMS)
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Maternal practices regarding children's health care have been recognized as an important factor associated with mortality rates among children < 5 years of age. We focused on health care-seeking practices of primary caretakers of children < 5 years of age with diarrheal disease in Kolkata. We interviewed caretakers of 1,058 children in a baseline survey and 6,077 children on six subsequent surveys. The prevalence of diarrhea during the preceding 2 weeks was 7.9% in the baseline survey and 5.7% (lowest 3.5% to highest 7.8%) in subsequent surveys. Multivariate logistic regression showed that formal education of primary caretakers was associated with seeking care outside the home (odds ratio [OR] = 15.5; 95% confidence interval [CI] [2.5–85.7]; = 0.002). Multinomial logistic regression showed that formal education of the primary caretaker (OR = 21.4; 95% CI [3.2–139.0]; = 0.002) and presence of dry mouth during diarrhea (OR = 17.3; 95% CI [2.7–110.9]; = 0.003) were associated with seeking care from licensed providers compared with the children for whom care was not sought outside of the home. This health care utilization and attitudes survey (HUAS) can serve as a tool to identify the factors that influence a better health care-seeking pattern in urban slums of Kolkata.

[open-access] This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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  1. Duggal R, , 1986. Health Expenditure in India. Foundation for Research in Community Health Newsletter 1.1. Mumbai: Foundation for Research in Community Health. [Google Scholar]
  2. Seal SC, , 1961, 1962, 1963. Reports of the General Survey in Madhya Pradesh, Bengal, Bihar, Rajasthan, Assam, Uttar Pradesh, and Manipur. New Delhi: Directorate General of Health Services. [Google Scholar]
  3. Sundar R, , 1995. Household Survey of Health Care Utilization and Expenditure. Working Paper No. 53. New Delhi: National Council of Applied Economic Research. [Google Scholar]
  4. Deshmukh PR, Dongre AR, Sinha N, Garg BS, , 2009. Acute childhood morbidities in rural Wardha: some epidemiological correlates and health care seeking. Indian J Med Sci 63: 345354.[Crossref] [Google Scholar]
  5. Black RE, Morris SS, Bryce J, , 2003. Where and why are 10 million children dying every year? Lancet 361: 22262234.[Crossref] [Google Scholar]
  6. Bryce J, Boschi-Pinto C, Shibuya K, Black ER, , 2005. WHO estimates of the causes of death in children. Lancet 365: 11471152.[Crossref] [Google Scholar]
  7. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, for the Child Health Epidemiology Reference Group of WHO and UNICEF, , 2010. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375: 19691987.[Crossref] [Google Scholar]
  8. Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK, Shet A, Ram U, Gaffey MF, Black RE, Jha P, Million Death Study Collaborators, , 2010. Causes of neonatal and child mortality in India: a nationally representative mortality survey. Lancet 376: 18531860.[Crossref] [Google Scholar]
  9. Victoria CG, Bryce J, Fontaine O, Monasch R, , 2000. Reducing deaths from diarrhea through oral rehydration therapy. Bull World Health Organ 78: 12461255. [Google Scholar]
  10. Pelto PJ, Pelto PH, , 1992. Developing applied medical anthropology in Third World countries. Soc Sci Med 35: 13891395.[Crossref] [Google Scholar]
  11. Shaik BT, Hatcher J, , 2004. Health-seeking behavior and health service utilization in Pakistan: challenging the policy makers. Advance Access Publication 27: 4954. [Google Scholar]
  12. Claeson M, Waldman RJ, , 2000. The evolution of child health programmes in developing countries: from targeting diseases to targeting people. Bull World Health Organ 78: 12341245. [Google Scholar]
  13. Awasthi S, Agarwal S, , 2003. Determinants of childhood mortality and morbidity in urban slums in India. Indian Pediatr 40: 11451161. [Google Scholar]
  14. Sakisaka K, Jimba M, Hanada K, , 2010. Changing poor mothers' care-seeking behaviors in response to childhood illness: findings from a cross-sectional study in Granada, Nicaragua. BMC Int Health Hum Rights 10: 10.[Crossref] [Google Scholar]
  15. Stuyf PV, Sorensen SC, Delgado E, Bocaletti E, , 1996. Health seeking behavior for child illness in rural Guatemala. Trop Med Int Health 2: 161170. [Google Scholar]
  16. Martines J, Paul VK, Bhutta ZA, Koblinsky M, Soucat A, Walker N, Bahl R, Fogstad H, Costello A, Neonatal Survival Steering Team; , 2005. Neonatal survival: a call for action. Lancet 365: 11891197.[Crossref] [Google Scholar]
  17. Sur D, Deen JL, Manna B, Niyogi SK, Deb AK, Kanungo S, Sarkar BL, Kim DR, Danovaro-Holliday MC, Holliday K, Gupta VK, Ali M, von Seidlein L, Clemens JD, Bhattacharya SK, , 2005. The burden of cholera in the slums of Kolkata, India: data from a prospective, community based study. Arch Dis Child 90: 11751181.[Crossref] [Google Scholar]
  18. Badowski N, Castro CM, Montgomery M, Pickering AJ, Mamuya S, Davis J, , 2011. Understanding household behavioral risk factors for diarrheal disease in Dar es Salaam: a photovoice community assessment. J Environ Public Health Epub 2011: 130467. [Google Scholar]
  19. World Health Organization, 2002. Generic protocols for (i) hospital-based surveillance to estimate the burden of rotavirus gastroenteritis in children and (ii) a community-based survey on utilization of health care services for gastroenteritis in children: Field test version. Geneva: WHO.
  20. Nasrin D, Wu Y, Blackwelder WC, Farag TH, Saha D, Sow SO, Alonso PL, Breiman RF, Sur D, Faruque ASG, Zaidi AKM, Biswas K, Van Eijk AM, Walker DG, Levine MM, Kotloff KL, , 2013. Health care seeking for childhood diarrhea in developing countries: evidence from seven sites in Africa and Asia. Am J Trop Med Hyg 89 (Suppl 1): 312.[Crossref] [Google Scholar]
  21. Korn EL, Graubard BI, , 1999. Analysis of Health Surveys. New York: Wiley, 124125.[Crossref] [Google Scholar]
  22. Breiman RF, Olack B, Shultz A, Roder S, Kimani K, Feikin DR, Burke H, , 2011. Healthcare-use for major infectious disease syndromes in an informal settlement in Nairobi, Kenya. J Health Popul Nutr 29: 123133.[Crossref] [Google Scholar]
  23. Pérez-Cuevas R, Guiscafré H, Romero G, Rodríguez L, Gutiérrez G, , 1996. Mothers' health-seeking behavior in acute diarrhea in Tlaxcala, Mexico. J Diarrhoeal Dis Res 14: 260268. [Google Scholar]
  24. Sur D, Manna B, Deb AK, Deen JL, Danovaro-Holliday MC, von Seidlein L, Clemens JD, Bhattacharya SK, , 2004. Factors associated with reported diarrhea episodes and treatment-seeking in an urban slum of Kolkata, India. J Health Popul Nutr 22: 130138. [Google Scholar]
  25. Sengupta PG, Mandal S, Sen D, Das P, Deb BC, Pal SC, , 1990. Multidrug resistant epidemic Shigellosis in a village in west Bengal, 1984. Indian J Public Health 34: 1519. [Google Scholar]
  26. Garg P, Chakraborty S, Basu I, Datta S, Rajendran K, Bhattacharya T, Yamasaki S, Bhattacharya SK, Takeda Y, Nair GB, Ramamurthy T, , 2000. Expanding multiple antibiotic resistance among clinical strains of Vibrio cholerae isolated from 1992–97 in Calcutta, India. Epidemiol Infect 124: 393399.[Crossref] [Google Scholar]
  27. Srinivasa H, Baijayanti M, Raksha Y, , 2009. Magnitude of drug resistant Shigellosis: a report from Bangalore. Indian J Med Microbiol 27: 358360.[Crossref] [Google Scholar]
  28. Dutta S, Rajendran K, Roy S, Chatterjee A, Dutta P, Nair GB, Bhattacharya SK, Yoshida SI, , 2002. Shifting serotypes, plasmid profile analysis and antimicrobial resistance pattern of shigellae strains isolated from Kolkata, India during 1995–2000. Epidemiol Infect 1299: 235243. [Google Scholar]
  29. Roychowdhury A, Pan A, Dutta D, Mukhopadhyay AK, Ramamurthy T, Nandy RK, Bhattacharya SK, Bhattacharya MK, , 2008. Emergence of tetracycline-resistant Vibrio cholerae O1 serotype Inaba, in Kolkata, India. Jpn J Infect Dis 61: 235243. [Google Scholar]
  30. Bhattacharya K, Kanungo S, Sur D, Sarkar BL, Manna B, Lopez AL, Bhattacharya M, Nandy S, Niyogi SK, , 2011. Tetracycline-resistant Vibrio cholerae O1, Kolkata, India. Emerg Infect Dis 17: 568569.[Crossref] [Google Scholar]

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  • Received : 13 Dec 2012
  • Accepted : 15 Apr 2013
  • Published online : 10 Jul 2013

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