TY - JOUR
T1 - Predictors of diarrheal mortality and patterns of caregiver health seeking behavior in in Karachi, Pakistan
AU - Qamar, Farah Naz
AU - Zaman, Umber
AU - Quadri, Farheen
AU - Khan, Asia
AU - Shaikh, Babar Tasneem
AU - Azam, Iqbal
AU - Nasrin, Dilruba
AU - Kotloff, Karen
AU - Levine, Myron
AU - Brown, Nick
AU - Zaidi, Anita K.M.
PY - 2016
Y1 - 2016
N2 - Background Pakistan is unfortunately among the five countries that contributed to the most deaths due to diarrhea and pneumonia in 2010. To explore factors associated with diarrheal deaths we assessed care-seeking behavior and other predictors of diarrhea-related mortality in children in selected low-income peri-urban communities of Karachi, Pakistan. Methods A mixed methods study (qualitative and quantitative) using matched case-control design and focus group discussions with parents of children with moderate to severe diarrhea (MSD) was undertaken. Cases were children < 5 years of age who died within 60 days of developing an episode of MSD. Controls were age-matched children who survived after 60 days of an episode of MSD. Demographic, clinical, and care-related behavioral predictors of mortality were assessed. Conditional logistic regression was performed, matched adjusted odds ratios (mOR) are reported. Results Parents of 77 cases and 154 controls were interviewed. Cases were less likely to receive appropriate care compared to controls (mOR = 0.2, 95% confidence interval (CI) 0.05-0.91). Refusal for hospital admission (OR = 8.9, 95% CI 2.6-30.8), and delays in reaching the health facility (OR = 3.6, 95% CI 1.0-12.9) were significant independent predictors of mortality. We found strong beliefs in traditional and spiritual healing in the population; use of both modern and traditional/spiritual treatments concurrently was common. Conclusion Appropriate care seeking behavior predicts survival in children with diarrhea in Pakistan. There is a complex belief system relating to traditional and standard therapies. Health education for appropriate health care seeking should be implemented in order to achieve a substantial decline in diarrheal disease mortality in Pakistan.
AB - Background Pakistan is unfortunately among the five countries that contributed to the most deaths due to diarrhea and pneumonia in 2010. To explore factors associated with diarrheal deaths we assessed care-seeking behavior and other predictors of diarrhea-related mortality in children in selected low-income peri-urban communities of Karachi, Pakistan. Methods A mixed methods study (qualitative and quantitative) using matched case-control design and focus group discussions with parents of children with moderate to severe diarrhea (MSD) was undertaken. Cases were children < 5 years of age who died within 60 days of developing an episode of MSD. Controls were age-matched children who survived after 60 days of an episode of MSD. Demographic, clinical, and care-related behavioral predictors of mortality were assessed. Conditional logistic regression was performed, matched adjusted odds ratios (mOR) are reported. Results Parents of 77 cases and 154 controls were interviewed. Cases were less likely to receive appropriate care compared to controls (mOR = 0.2, 95% confidence interval (CI) 0.05-0.91). Refusal for hospital admission (OR = 8.9, 95% CI 2.6-30.8), and delays in reaching the health facility (OR = 3.6, 95% CI 1.0-12.9) were significant independent predictors of mortality. We found strong beliefs in traditional and spiritual healing in the population; use of both modern and traditional/spiritual treatments concurrently was common. Conclusion Appropriate care seeking behavior predicts survival in children with diarrhea in Pakistan. There is a complex belief system relating to traditional and standard therapies. Health education for appropriate health care seeking should be implemented in order to achieve a substantial decline in diarrheal disease mortality in Pakistan.
UR - http://www.scopus.com/inward/record.url?scp=85010333213&partnerID=8YFLogxK
U2 - 10.7189/jogh.06.020406
DO - 10.7189/jogh.06.020406
M3 - Article
C2 - 27606059
AN - SCOPUS:85010333213
SN - 2047-2978
VL - 6
JO - Journal of Global Health
JF - Journal of Global Health
IS - 2
M1 - 020406
ER -