Abstract
Increased diarrheal episode severity has been linked to better 2-week recall and improved care-seeking and treatment among caregivers of children under five. Using cross-sectional data from three Indian states, we sought to assess the relationship between episode severity and the recall, care-seeking, and treatment of childhood diarrhea. Recall error was higher for episodes with onset 8–14 days (31.2%) versus 1–7 days (4.8%) before the survey, and logistic regression analysis showed a trend toward increased severity of less recent compared with more recent episodes. This finding indicates that data collection with 2-week recall underestimates diarrhea prevalence while overestimating the proportion of severe episodes. There was a strong correlation between care-seeking and dehydration, fever, vomiting, and increased stool frequency and duration. Treatment with oral rehydration salts was associated with dehydration, vomiting, and higher stool frequency, and trends were established between therapeutic zinc supplementation and increased duration and stool frequency. However, state and care-seeking sector were stronger determinants of treatment than episode severity, illustrating the need to address disparities in treatment quality across regions and delivery channels. Our findings are of importance to researchers and diarrhea management program evaluators aiming to produce accurate estimates of diarrheal outcomes and program impact in low- and middle-income countries.
Highlights
Diarrhea is a leading cause of morbidity and mortality among children under five worldwide.[1,2] Cross-sectional household surveys are typically used to measure diarrhea prevalence, care-seeking, and treatment among young children in low- and middle-income countries (LMIC)
CI = confidence interval; OR = odds ratio; UP = Uttar Pradesh. *Logistic regression analyses were performed in Stata 12.0 with the robust cluster estimator of variance to account for intra-village correlation.22 †Analysis was adjusted for all listed variables, as well as child’s age and gender, caregiver education in total years of schooling, phase of data collection, and whether the child had recovered from the diarrheal episode at the time of the survey
The results of this study demonstrate the potential influence of diarrheal episode characteristics on the recall, care-seeking, and treatment of diarrhea among children under five
Summary
Diarrhea is a leading cause of morbidity and mortality among children under five worldwide.[1,2] Cross-sectional household surveys are typically used to measure diarrhea prevalence, care-seeking, and treatment among young children in low- and middle-income countries (LMIC). The advantages of cross-sectional data collection include estimation of point or period prevalence, as well as relative quickness and inexpensiveness when compared with longitudinal data collection.[3] The 2-week period prevalence of diarrhea is a routinely collected indicator used to monitor the status of child health in countries worldwide.[4,5]. The accuracy of calling upon caregivers of children under five to recall the occurrence of diarrhea during the period of 2 weeks preceding a household visit has been called into question.[6,7,8,9,10] Assuming that diarrhea is likely to occur at any point during a short time period (i.e., during the same diarrhea season), the number of episodes reported on each day within a recall interval should be comparable.[7,9] studies have suggested that caregivers may fail to remember illness occurring earlier in the recall period, and such recall errors bias estimates of 2-week diarrhea prevalence.[6,7,8,9,10]
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