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

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 stratified 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.