Title: Care-seeking patterns for common pediatric illnesses: A mixed methods study in rural Guatemala

Abstract

Background: Despite impressive economic growth, Guatemala continues to experience high levels of poverty and a disproportionate disease burden of preventable childhood illnesses. A mixed-methods study was conducted to determine care-seeking patterns and barriers to care for common pediatric illnesses in rural communities.

Methods: Household surveys and formative assessments were conducted in four districts/sub-districts to elicit information on care-seeking practices and barriers for child illness.

Results: Facility-based care for symptoms of Acute Respiratory Infection (ARI), diarrhea, and fever, was reported by <25% of caretakers, with <5% reporting prompt care-seeking. Treatment with antibiotics for ARI symptoms was reported by 47.8% of caretakers while 77.8% reported Oral Rehydration Therapy (ORT) treatment for diarrhea. Community health workers/health posts were the primary source of care (75%), with 17.6% of caretakers reporting facility care. Children from wealthier quintiles had twice the odds of facility-based care than the poorest families (OR 2.78, 95% CI 1.32-5.83). Other factors significantly associated with care-seeking were younger children and 2 or more comorbidities. Qualitative findings indicated that the major barriers to appropriate and timely care-seeking were cultural preferences for traditional treatment, perceived illness severity, lack of spousal consent, geographical and financial access to facilities, distrust of health providers, and long wait times.

Conclusion: Treatment decision making for pediatric care is a complex and dynamic process influenced by multiple factors. As global efforts accelerate for universal health coverage and people centered care, investments for community-oriented healthcare is of paramount importance.