Abstract

Estimates place the global death toll from diarrhoeal diseases at about 1.3 million deaths in 2008, ranking second among all causes of deaths and in Pakistan alone 16% of the half million deaths in children who did not live to see their fifth birthday were caused by diarrhoea. We aimed to see the differences in the healthcare seeking behaviours of caretakers for children less than five year of age who died of severe diarrhoea compared to those with non-fatal severe diarrhoea. A mixed method study including a matched case-control study and focus group discussions was performed. Cases and their age and neighbourhood matched controls included 0–59 months old children who had fatal severe diarrhoea and non fatal severe diarrhoea respectively. Using statistical analysis system (SAS), conditional logistic regression showed that the odds of provision of appropriate care (going to a licensed doctor within 24 h from the recognition of the illness) were 80% (MORadj=0.2, 95% CI 0.05 to 0.91) less in children with fatal severe diarrhoea than in children with non-fatal severe diarrhoea. Supporting these qualitative results showed switching and simultaneous treatment from traditional, spiritual and modern healers. Moreover refusal to hospital admission due to limited decision making or due to self treatment at home, delays in time to reach health facility, not boiling drinking water due to lack of awareness, inadequate knowledge and misconceptions regarding ORS, use of public sources of drinking water and presence of blood in stools were other factors found in our triangulated results.