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

Abstract

Abstract.

Diarrhea causes 16% of all child deaths in Pakistan. We assessed patterns of healthcare use among caretakers of a randomly selected sample of 959 children ages 0–59 months in low-income periurban settlements of Karachi through a cross-sectional survey. A diarrheal episode was reported to have occurred in the previous 2 weeks among 298 (31.1%) children. Overall, 280 (80.3%) children sought care. Oral rehydration solution and zinc were used by 40.8% and 2%, respectively; 11% were admitted or received intravenous rehydration, and 29% sought care at health centers identified as sentinel centers for recruiting cases of diarrhea for a planned multicenter diarrheal etiology case-control study. Odds ratios for independent predictors of care-seeking behavior were lethargy, 4.14 (95% confidence interval = 1.45–11.77); fever, 2.67 (1.27–5.59); and stool frequency more than six per day, 2.29 (1.03–5.09). Perception of high cost of care and use of home antibiotics were associated with reduced care seeking: odds ratio = 0.28 (0.1–0.78) and 0.29 (0.11–0.82), respectively. There is a need for standardized, affordable, and accessible treatment of diarrhea as well as community education regarding appropriate care in areas with high diarrheal burden.

[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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2013-07-10
2017-09-21
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References

  1. Fischer Walker CL, Perin J, Aryee MJ, Boschi-Pinto C, Black RE, , 2012. Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review. BMC Public Health 12: 220.[Crossref]
  2. Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M, Mathers C, Rivera J, , 2008. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371: 243260.[Crossref]
  3. Kotloff KL, Blackwelder WC, Nasrin D, Nataro JP, Farag TH, van Eijk A, Adegbola RA, Alonso PL, Breiman RF, Golam Faruque AS, Saha D, Sow SO, Sur D, Zaidi AK, Biswas K, Panchalingam S, Clemens JD, Cohen D, Glass RI, Mintz ED, Sommerfelt H, Levine MM, , 2012. The Global Enteric Multicenter Study (GEMS) of diarrheal disease in infants and young children in developing countries: epidemiologic and clinical methods of the case/control study. Clin Infect Dis 55 (Suppl 4): S232S245.[Crossref]
  4. 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]
  5. WHO, 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: World Health Organization.
  6. Owais A, Sultana S, Stein AD, Bashir NH, Awaldad R, Zaidi AK, , 2011. Why do families of sick newborns accept hospital care? A community-based cohort study in Karachi, Pakistan. J Perinatol 31: 586592.[Crossref]
  7. Shaikh BT, Hatcher J, , 2005. Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. J Public Health (Bangkok) 27: 49.[Crossref]
  8. Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L, , 2005. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 365: 977988.[Crossref]
  9. National Institute of Population Studies I, Pakistan, 2007. Pakistan Demographic and Health Survey 2006. Columbia, MA: IRD/Macro International, 2007.
  10. Government of Pakistan SD, Federal Bureau of Statistics, 2011. Pakistan Social and Living Standards Measurement Survey (Pslm) 2010–11. Islamabad: Government of Pakistan.
  11. Kosek M, Bern C, Guerrant RL, , 2003. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ 81: 197204.
  12. El-Gilany AH, Hammad S, , 2005. Epidemiology of diarrhoeal diseases among children under age 5 years in Dakahlia, Egypt. East Mediterr Health J 11: 762775.
  13. Kotloff KL, Winickoff JP, Ivanoff B, Clemens JD, Swerdlow DL, Sansonetti PJ, Adak GK, Levine MM, , 1999. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull World Health Organ 77: 651666.
  14. Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S, , 2001. Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics 108: e67.[Crossref]
  15. Quigley MA, Kelly YJ, Sacker A, , 2007. Breastfeeding and hospitalization for diarrheal and respiratory infection in the United Kingdom Millennium Cohort Study. Pediatrics 119: e837.[Crossref]
  16. Lamberti LM, Fisher Walker CL, Noiman A, Victora C, Black RE, , 2011. Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health 11 (Suppl 3): S15.[Crossref]
  17. Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM, , 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 4252.[Crossref]
  18. Aamer I, Yawar YM, Zulfiqar B, , 2011. Effect of breastfeeding promotion interventions on breastfeeding rates, with special focus on developing countries. BMC Public Health 11 (Suppl 3): S24.
  19. WHO, 2011. World Malaria Report. Available at: http://www.who.int/malaria/world_malaria_report_2011/9789241564403_eng.pdf. Accessed July 1, 2012.
  20. National Nutritional Survey of Pakistan, 2011. Department of Paediatrics and Child Health, Aga Khan University. Available at: http://pakresponse.info/LinkClick.aspx?fileticket=BY8AFPcHZQo%3D&tabid. Accessed July 5, 2012.
  21. Pakistan Meteorological Department. Islamabad: Government of Pakistan. Available at: http://www.pmd.gov.pk/. Accessed July 1, 2012.
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Supplementary Data

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  • Received : 13 Dec 2012
  • Accepted : 30 Jan 2013

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