Am J Trop Med Hyg. 2013 Jul;89(1 Suppl):49-55. doi: 10.4269/ajtmh.12-0757. Epub 2013 Apr 29.
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.
在巴基斯坦，腹泻导致 16%的儿童死亡。我们通过横断面调查评估了随机选择的 959 名 0-59 个月龄低收入城郊定居点儿童看护人样本中腹泻的医疗服务使用模式。在过去的 2 周中，有 298 名（31.1%）儿童报告发生腹泻。总体而言，有 280 名（80.3%）儿童寻求医疗服务。有 40.8%的儿童使用口服补液盐，2%的儿童使用锌；11%的儿童住院或接受静脉补液，29%的儿童到被确定为招募腹泻病例的哨点卫生中心就诊，以开展一项多中心腹泻病因病例对照研究。寻求医疗服务行为的独立预测因素的比值比分别为：昏睡 4.14（95%置信区间=1.45-11.77）；发热 2.67（1.27-5.59）；每天排便次数超过 6 次 2.29（1.03-5.09）。认为治疗费用高和使用家庭抗生素与减少寻求医疗服务有关：比值比分别为 0.28（0.1-0.78）和 0.29（0.11-0.82）。需要标准化、负担得起且可获得的腹泻治疗方法以及在腹泻负担高的地区开展有关适当护理的社区教育。
