Predictors of Treatment-Seeking Behavior Among Bolivian Caregivers of Children Under Five With Acute Diarrhea Open Access
Ragan, Stephen Taylor (2014)
Abstract
In 2010, Bolivia's under-five mortality rate (per 1,000 live births) was 54 deaths, much higher than the regional average of 18 deaths. Diarrheal illness is responsible for an estimated 9% of Bolivia's elevated <5 mortality. Because both the economic burden and heath outcomes of childhood diarrhea may be associated with the treatment-seeking behavior of caregivers, the primary goal of this study was to identify predictors of treatment-seeking behavior among Bolivian caregivers of children under five years old with an acute diarrheal illness. In order to assess whether any of the six specified risk factors (e.g., age of child; gender of child; rural vs. urban home environment; reported history of difficulty paying for treatment; reported history of withholding treatment because of fear of cost; and monthly household income) were good predictors of treatment-seeking behavior, we collected data from caregivers in six Bolivian hospitals from 2007 to 2009. The strength of the six specified risk factors as predictors of treatment-seeking behavior was assessed through three separate regression analyses. This study found that the age of the child was a strong predictor of the type of treatment (informal care vs. formal care vs. a combination of both) sought by caregivers. Children aged one year or younger were significantly less likely to receive a combination of informal and formal care than were children older than one year. In terms of when medical care was accessed, a caregiver's past behavior was found to be a strong predictor of future behavior. A history of having not sought medical care because of fear of cost was significantly associated with longer delays in caregivers taking a child with diarrhea to the hospital. Interestingly, household income was not significantly associated with the type nor the timing of medical treatments accessed by caregivers. These results suggest that both patient-specific risk factors (e.g., age) and caregiver-specific risk factors (e.g., a history of withholding treatment because of fear of cost) can serve as predictors of treatment-seeking behavior. Studies such as this deepen our understanding of the associations between risk factors and caregiver behavior and can help inform public health policy.
Table of Contents
LITERATURE REVIEW........... 1 Global Burden of Disease........ 1 Epidemiology of Rotavirus Gastroenteritis........ 1 Epidemiology of Rotavirus Gastroenteritis........ 1 Pathophysiology of Rotavirus Gastroenteritis........ 2 Rotavirus Virology........ 3 Rotavirus Vaccination........ 3 Rotavirus Vaccine Availability........ 4 Global Costs of Rotavirus Gastroenteritis........ 5 Cost Effectiveness of Rotavirus Vaccination........ 9
Factors Associated With Seeking Professional Medical Treatment for Childhood Diarrhea........ 11
Bolivia........ 12 Rotavirus Disease and Vaccination in Bolivia........ 15 Gaps in Knowledge and Need........ 16 Goals and Aims........ 16 Significance........ 17 METHODS........... 18 Participants........ 18 Data Collection and Management........ 19 Analysis........ 20 RESULTS........... 23 Characteristics of the Analysis Sample........ 23 Predictors of Treatment-Seeking Behavior........ 23 DISCUSSION........... 27 Strengths and Limitations........ 29 Recommendations for Future Research........ 30 Conclusion........ 30 PUBLIC HEALTH IMPLICATIONS........... 32 TABLES........... 40 APPENDIX: International Review Board Approval........... 43About this Master's Thesis
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