The Influence of Episode Severity on Caregiver Recall, Care-seeking, and Treatment of Diarrhea Among Children 2-59 Months of Age in Bihar, Gujarat, and Uttar Pradesh, India.
The Influence of Episode Severity on Caregiver Recall, Care-seeking, and Treatment of Diarrhea Among Children 2-59 Months of Age in Bihar, Gujarat, and Uttar Pradesh, India.
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DOI：
10.4269/ajtmh.14-0727
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发表时间：
2015-08
期刊：
影响因子：
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通讯作者：
Black RE
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文献类型：
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作者：
Lamberti LM;Fischer Walker CL;Taneja S;Mazumder S;Black RE
腹泻发作严重程度的增加与 5 岁以下儿童的看护者更好的两周回忆以及改善的寻求护理和治疗有关。我们利用印度三个州的横断面数据，试图评估儿童腹泻发作严重程度与回忆、就医和治疗之间的关系。调查前 8-14 天发作的事件 (31.2%) 的回忆错误率高于 1-7 天发作的事件 (4.8%)，逻辑回归分析显示，与最近发生的事件相比，近期事件的严重程度有增加的趋势。这一发现表明，两周回忆的数据收集低估了腹泻患病率，同时高估了严重发作的比例。寻求护理与脱水、发烧、呕吐以及大便频率和持续时间增加之间存在很强的相关性。口服补液盐治疗与脱水、呕吐和大便频率增加有关，并且在治疗性锌补充剂与增加持续时间和大便频率之间建立了趋势。然而，与事件严重程度相比，国家和寻求护理的部门是治疗的更强决定因素，这表明需要解决不同地区和交付渠道之间治疗质量的差异。我们的研究结果对于研究人员和腹泻管理计划评估人员非常重要，旨在准确估计低收入和中等收入国家的腹泻结果和计划影响。
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.