1Antimicrobial Resistance and Infectious Diseases Laboratory (AMRID), College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia.
2Thi-Qar Public Health Division, Ministry of Health, Thi-Qar, Iraq.
Am J Trop Med Hyg. 2020 Dec 7;104(2):748-755. doi: 10.4269/ajtmh.20-0529.
Diarrhea remains a significant cause of child morbidity and mortality in Iraq. The objective of this study was to examine the current practices of home-based management of diarrheal illnesses among Iraqi children. We surveyed mothers of children aged less than 5 years to identify the sociodemographic factors associated with maternal healthcare-seeking practices. A total of 500 mother-child pairs were interviewed in a cross-sectional household survey in Thi-Qar Governorate, southeastern Iraq, between March 2016 and February 2017. Logistic and multinomial regression models were used to infer sociodemographic predictors of the healthcare-seeking and alternative management practices adopted by the mothers. The interviewees reported that 35.2% of their children had diarrhea in the 2 weeks before the survey. The least likelihood of reported occurrence of diarrhea was among mother-child pairs where the mothers had received university education, as compared with mothers who were illiterate or received only primary or secondary education. Lower odds (odds ratio = 0.4, P-value < 0.001) of reported childhood diarrhea was revealed among mothers aged > 25 years than among those younger. Self-ordered medicine from a pharmacy was the most preferred alternative management option in almost half (52.4% [262/500]) of the interviewed mothers in Thi-Qar. Interestingly, 69.6% (348/500) of the mothers reported supplying their children suffering from diarrhea with antibiotics. Relative to mothers with university education, those with high school education had more likelihood of selecting medical center (relative risk ratio [rrr] = 2.4) and pharmacy (rrr = 3.7) as against no treatment. Lower maternal educational level, mothers' age < 25 years, and the district of residence were important factors associated with diarrhea occurrence among children younger than 5 years. In light of the findings from this study, intervention aimed at improving healthcare seeking for managing diarrhea in Iraqi children should jointly consider the influence of mothers age, education, as well as the level of economic status of the communities in which mothers of these children reside. The results of this study indicate the need for enhancing public health education to improve the maternal management of diarrheal disease and the avoidance of unnecessary use of antimicrobials.
腹泻仍然是伊拉克儿童发病率和死亡率的一个主要原因。本研究的目的是调查伊拉克儿童家庭腹泻病管理的现行做法。我们对 5 岁以下儿童的母亲进行了调查，以确定与母亲寻求医疗保健做法相关的社会人口因素。2016 年 3 月至 2017 年 2 月，在伊拉克东南部济加尔省进行了一项横断面家庭调查，共对 500 对母婴进行了访谈。使用逻辑回归和多项回归模型推断母亲寻求医疗保健和采用替代管理做法的社会人口预测因素。受访者报告说，在调查前两周，他们的 35.2%的孩子腹泻。与不识字或只接受过小学或中学教育的母亲相比，接受过大学教育的母亲报告其孩子发生腹泻的可能性最低。与年龄<25 岁的母亲相比，年龄>25 岁的母亲报告儿童腹泻的可能性较低（比值比=0.4，P 值<0.001）。在接受采访的济加尔母亲中，近一半（52.4%[262/500]）首选自行从药店购买药物作为替代管理选择。有趣的是，69.6%（348/500）的母亲报告给患有腹泻的孩子提供抗生素。与受过大学教育的母亲相比，接受过高中教育的母亲更有可能选择医疗中心（相对风险比[rrr]=2.4）和药店（rrr=3.7）而不是不治疗。母亲教育程度较低、年龄<25 岁以及居住地是与 5 岁以下儿童腹泻发生相关的重要因素。鉴于本研究的结果，旨在改善伊拉克儿童腹泻管理的医疗保健寻求的干预措施应共同考虑母亲年龄、教育以及儿童母亲所在社区经济状况的影响。本研究结果表明，需要加强公众健康教育，以改善对腹泻病的母婴管理，并避免不必要地使用抗生素。
