Global Trends in Care Seeking for Children with Diarrhea: A Theoretically Grounded Exploration of Care Seeking Behavior Among the Countries of USAID's Demographic Health Surveys Open Access

Robinson, Anne Elizabeth (2014)

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Background and Objectives: This study provides a theoretically grounded foundation to exploring global care seeking trends for childhood diarrheal illnesses. In order to inform current global surveillance and intervention efforts, this study explored how different characteristics influenced any care seeking outside the home as well as care seeking at a medical facility.

Methods: Using data provided by the standard Demographic Health Surveys (DHS), this study provides the first step by exploring what individual and household characteristics are consistently influential in care seeking at a global level. All DHS datasets with measures of recent diarrheal illness were included in analysis. Predictor variables were justified and organized into a multivariate statistical model using Andersen's Health Behavior Model.

Results: Nearly 1.4 million children across 73 low- and middle-income countries were included in this study. Of these children, 16.5% had a diarrheal episode in the preceding two weeks. Fifty-three percent of these children were taken to some form of care outside the home, and 39.8% were taken to care at a medical facility. Overall, most predictor variables explored in this study were found to have some amount of influence on global care seeking practices for children with diarrhea. For both general care seeking as well as medical care seeking, a higher proportion of children with bloody stools and fever being taken to care. Globally, wealth had a positive relationship with care seeking, as did educational attainment of both the mother and father. Additionally, use of prenatal care was found to have a significant impact on care seeking, with prenatal care users being nearly twice as likely to seek care at a medical facility.

Conclusion: The results of this study indicate that medically based surveillance sites do capture a slightly biased sample of children with diarrheal illnesses. Childhood diarrheal surveillance should seek to adjust their observations of treated prevalence based on these uncovered influences in seeking medical care. Furthermore, these findings should be incorporated into future global care seeking intervention and policy efforts as well as provide a comparative structure from which to organize future diarrheal care seeking research.

Table of Contents

TABLE OF CONTENTS I. INTRODUCTION 6 II. LITERATURE REVIEW 9 Global Burden of Diarrhea 9 Clinical Surveillance and the Lab 9 Community-Based Surveillance 10 Current Findings 11 Varying Rates of Care Seeking 11 Influences on Care Seeking - Perceptions of Severity 12 Influences on Care Seeking - the Child and the Household 13 Theoretical Frameworks 15 Existing Behavior Models 15 Care Seeking Behavior Models 17 Study Justification and Research Questions: 18 III. METHODS 20 DHS Instrument 20 Data Collection Procedures 20 Compiling DHS Datasets for Analysis 21 Study Population and Sample Size 23 Measures 24 Outcome Measures 24 Predictor Variables 24 Stages of Analyses 27 IV. RESULTS 29 Diarrheal Prevalence and Care Seeking Rates by Country 29 Any Care Seeking 34 Medical Care Seeking 38 HIV Status and Care Seeking 42 V. DISCUSSION 42 Summary of Key Findings 42 Connections to Previous Research 44 Informing Current Global Efforts 44 Introduction of Theoretical Structure 47 Limitations 48 Future Research 50 REFERENCES 54 APPENDIX I: Multivariate Logistic Regression Output for Non-Medical Care Seeking 57 APPENDIX II: Questions from the Demographic Health Surveys 58

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