Patterns of Care Seeking During Episodes of Childhood Diarrhea and its Relation to Preventive Care Patterns: National Integrated Monitoring and Evaluation Survey (IMES) of Family Health. Islamic Republic of Iran

Abstract

Background: In Iran, diarrheal disease is the fourth cause of  
under five‑year mortality. Proper care‑seeking behavior and
system‑based disease management in the national field will have a great effect in reducing morbidity and mortality.
Methods: This nationwide study was performed on a target
population of  rural and urban communities; in all 31 provinces of the Islamic Republic of  Iran. One lakh three thousand three hundred and thirty one (103331) families were sampled by multi‑stage stratifed random sampling and were interviewed with a standard data collection form. The collected data was entered into the Stata  8.0 software and analyzed by the survey analysis method.
Results: Of  the 14625  (10.1%) children who were reported to
have diarrheal diseases two weeks prior to the interview, 8.8%
were cured and 1.5% were not. About 70% of  them had at least
one visit for health seeking the most of  patients were seen by
a rural health worker (Behvarz) in the rural and by a general
pediatrician in the urban areas. About 62% of  the patients in
urban and 57% in the rural areas had been treated with antibiotics and these rates for ORS were 51% and 65%, respectively. The factors most related to a care‑seeking pattern were the level of routine preventive well‑child care, number of  siblings, child age, and living area.
Conclusion: According to this national survey, our health system
needs to integrate all the levels of  prevention, especially the
Integrated Management of  Child Illnesses (IMCI) programs with a family physician project. Futher more, there is a great need for empowering the referral system and gate keeping in all referral levels, to make efficient national integrated programs.
Keywords: Diarrhea, antibiotic, health service, national survey,
preventive child care, referral system, Iran