Seeking Care for Pediatric Diarrheal Illness from Traditional Healers in Bamako, Mali
Identifieur interne : 002134 ( Pmc/Curation ); précédent : 002133; suivant : 002135Seeking Care for Pediatric Diarrheal Illness from Traditional Healers in Bamako, Mali
Auteurs : Tamer H. Farag ; Karen L. Kotloff ; Myron M. Levine ; Uma Onwuchekwa ; Anna Maria Van Eijk ; Sanogo Doh ; Samba O. SowSource :
- The American Journal of Tropical Medicine and Hygiene [ 0002-9637 ] ; 2013.
Abstract
Diarrhea is a leading cause of child mortality worldwide. Early recognition of symptoms and referral to medical treatment are essential. In 2007, we conducted a Healthcare Utilization and Attitudes Survey (HUAS) of 1,000 children randomly selected from a population census to define care-seeking patterns for diarrheal disease in Bamako, Mali, in preparation for the Global Enteric Multicenter Study (GEMS). We found that 57% of caretakers sought care for their child's diarrheal illness from traditional healers, and 27% of caretakers sought care from the government health center (GHC). Weighted logistic regression showed that seeking care from a traditional healer was associated with more severe reported diarrheal disease, like decreased urination (odds ratio [OR] = 3.35, 95% confidence interval [95% CI] = 1.19–9.41) and mucus or pus in stool (OR = 4.42, 95% CI = 1.35–14.51), along with other indicators of perceived susceptibility. A locally designed traditional healer referral system was, therefore, created that emphasized more severe disease. This system may serve as a model for health systems in West Africa.
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DOI: 10.4269/ajtmh.12-0753
PubMed: 23629935
PubMed Central: 3748497
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Seeking Care for Pediatric Diarrheal Illness from Traditional Healers in Bamako, Mali</title><author><name sortKey="Farag, Tamer H" sort="Farag, Tamer H" uniqKey="Farag T" first="Tamer H." last="Farag">Tamer H. Farag</name></author><author><name sortKey="Kotloff, Karen L" sort="Kotloff, Karen L" uniqKey="Kotloff K" first="Karen L." last="Kotloff">Karen L. Kotloff</name></author><author><name sortKey="Levine, Myron M" sort="Levine, Myron M" uniqKey="Levine M" first="Myron M." last="Levine">Myron M. Levine</name></author><author><name sortKey="Onwuchekwa, Uma" sort="Onwuchekwa, Uma" uniqKey="Onwuchekwa U" first="Uma" last="Onwuchekwa">Uma Onwuchekwa</name></author><author><name sortKey="Van Eijk, Anna Maria" sort="Van Eijk, Anna Maria" uniqKey="Van Eijk A" first="Anna Maria" last="Van Eijk">Anna Maria Van Eijk</name></author><author><name sortKey="Doh, Sanogo" sort="Doh, Sanogo" uniqKey="Doh S" first="Sanogo" last="Doh">Sanogo Doh</name></author><author><name sortKey="Sow, Samba O" sort="Sow, Samba O" uniqKey="Sow S" first="Samba O." last="Sow">Samba O. Sow</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23629935</idno><idno type="pmc">3748497</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748497</idno><idno type="RBID">PMC:3748497</idno><idno type="doi">10.4269/ajtmh.12-0753</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002135</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002135</idno><idno type="wicri:Area/Pmc/Curation">002134</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002134</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Seeking Care for Pediatric Diarrheal Illness from Traditional Healers in Bamako, Mali</title><author><name sortKey="Farag, Tamer H" sort="Farag, Tamer H" uniqKey="Farag T" first="Tamer H." last="Farag">Tamer H. Farag</name></author><author><name sortKey="Kotloff, Karen L" sort="Kotloff, Karen L" uniqKey="Kotloff K" first="Karen L." last="Kotloff">Karen L. Kotloff</name></author><author><name sortKey="Levine, Myron M" sort="Levine, Myron M" uniqKey="Levine M" first="Myron M." last="Levine">Myron M. Levine</name></author><author><name sortKey="Onwuchekwa, Uma" sort="Onwuchekwa, Uma" uniqKey="Onwuchekwa U" first="Uma" last="Onwuchekwa">Uma Onwuchekwa</name></author><author><name sortKey="Van Eijk, Anna Maria" sort="Van Eijk, Anna Maria" uniqKey="Van Eijk A" first="Anna Maria" last="Van Eijk">Anna Maria Van Eijk</name></author><author><name sortKey="Doh, Sanogo" sort="Doh, Sanogo" uniqKey="Doh S" first="Sanogo" last="Doh">Sanogo Doh</name></author><author><name sortKey="Sow, Samba O" sort="Sow, Samba O" uniqKey="Sow S" first="Samba O." last="Sow">Samba O. Sow</name></author></analytic><series><title level="j">The American Journal of Tropical Medicine and Hygiene</title><idno type="ISSN">0002-9637</idno><idno type="eISSN">1476-1645</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Diarrhea is a leading cause of child mortality worldwide. Early recognition of symptoms and referral to medical treatment are essential. In 2007, we conducted a Healthcare Utilization and Attitudes Survey (HUAS) of 1,000 children randomly selected from a population census to define care-seeking patterns for diarrheal disease in Bamako, Mali, in preparation for the Global Enteric Multicenter Study (GEMS). We found that 57% of caretakers sought care for their child's diarrheal illness from traditional healers, and 27% of caretakers sought care from the government health center (GHC). Weighted logistic regression showed that seeking care from a traditional healer was associated with more severe reported diarrheal disease, like decreased urination (odds ratio [OR] = 3.35, 95% confidence interval [95% CI] = 1.19–9.41) and mucus or pus in stool (OR = 4.42, 95% CI = 1.35–14.51), along with other indicators of perceived susceptibility. A locally designed traditional healer referral system was, therefore, created that emphasized more severe disease. This system may serve as a model for health systems in West Africa.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Walker, Cl" uniqKey="Walker C">CL Walker</name></author><author><name sortKey="Aryee, Mj" uniqKey="Aryee M">MJ Aryee</name></author><author><name sortKey="Boschi Pinto, C" uniqKey="Boschi Pinto C">C Boschi-Pinto</name></author><author><name sortKey="Black, Re" uniqKey="Black R">RE Black</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Winch, Pj" uniqKey="Winch P">PJ Winch</name></author><author><name sortKey="Gilroy, Ke" uniqKey="Gilroy K">KE Gilroy</name></author><author><name sortKey="Doumbia, S" uniqKey="Doumbia S">S Doumbia</name></author><author><name sortKey="Patterson, Ae" uniqKey="Patterson A">AE Patterson</name></author><author><name sortKey="Daou, Z" uniqKey="Daou Z">Z Daou</name></author><author><name sortKey="Diawara, A" uniqKey="Diawara A">A 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Am J Trop Med Hyg</journal-id><journal-id journal-id-type="iso-abbrev">Am. J. Trop. Med. Hyg</journal-id><journal-id journal-id-type="publisher-id">tpmd</journal-id><journal-title-group><journal-title>The American Journal of Tropical Medicine and Hygiene</journal-title></journal-title-group><issn pub-type="ppub">0002-9637</issn><issn pub-type="epub">1476-1645</issn><publisher><publisher-name>The American Society of Tropical Medicine and Hygiene</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23629935</article-id><article-id pub-id-type="pmc">3748497</article-id><article-id pub-id-type="doi">10.4269/ajtmh.12-0753</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Seeking Care for Pediatric Diarrheal Illness from Traditional Healers in Bamako, Mali</article-title><alt-title alt-title-type="left-running-head">FARAG AND OTHERS</alt-title><alt-title alt-title-type="right-running-head">SEEKING CARE FOR PEDIATRIC DIARRHEAL ILLNESS IN BAMAKO, MALI</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Farag</surname><given-names>Tamer H.</given-names></name><xref ref-type="corresp" rid="COR1">*</xref></contrib><contrib contrib-type="author"><name><surname>Kotloff</surname><given-names>Karen L.</given-names></name></contrib><contrib contrib-type="author"><name><surname>Levine</surname><given-names>Myron M.</given-names></name></contrib><contrib contrib-type="author"><name><surname>Onwuchekwa</surname><given-names>Uma</given-names></name></contrib><contrib contrib-type="author"><name><surname>Van Eijk</surname><given-names>Anna Maria</given-names></name></contrib><contrib contrib-type="author"><name><surname>Doh</surname><given-names>Sanogo</given-names></name></contrib><contrib contrib-type="author"><name><surname>Sow</surname><given-names>Samba O.</given-names></name></contrib></contrib-group><aff id="AFF1">Department of Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland; Center for Vaccine Development—Mali, Bamako, Mali; Child and Reproductive Health Group, Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, United Kingdom</aff><author-notes><corresp id="COR1">*Address correspondence to Tamer H. Farag, Center for Vaccine Development, Department of Medicine, University of Maryland School of Medicine, HSF-1 Room 480, 685 West Baltimore Street, Baltimore, MD 21201. E-mail: <email>tfarag@medicine.umaryland.edu</email></corresp></author-notes><pub-date pub-type="ppub"><day>10</day><month>7</month><year>2013</year></pub-date><pub-date pub-type="pmc-release"><day>10</day><month>7</month><year>2013</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>89</volume><issue>1 Suppl</issue><fpage>21</fpage><lpage>28</lpage><history><date date-type="received"><day>13</day><month>12</month><year>2012</year></date><date date-type="accepted"><day>09</day><month>4</month><year>2013</year></date></history><permissions><copyright-statement>©The American Society of Tropical Medicine and Hygiene</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access"><license-p>This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Diarrhea is a leading cause of child mortality worldwide. Early recognition of symptoms and referral to medical treatment are essential. In 2007, we conducted a Healthcare Utilization and Attitudes Survey (HUAS) of 1,000 children randomly selected from a population census to define care-seeking patterns for diarrheal disease in Bamako, Mali, in preparation for the Global Enteric Multicenter Study (GEMS). We found that 57% of caretakers sought care for their child's diarrheal illness from traditional healers, and 27% of caretakers sought care from the government health center (GHC). Weighted logistic regression showed that seeking care from a traditional healer was associated with more severe reported diarrheal disease, like decreased urination (odds ratio [OR] = 3.35, 95% confidence interval [95% CI] = 1.19–9.41) and mucus or pus in stool (OR = 4.42, 95% CI = 1.35–14.51), along with other indicators of perceived susceptibility. A locally designed traditional healer referral system was, therefore, created that emphasized more severe disease. This system may serve as a model for health systems in West Africa.</p></abstract></article-meta></front><floats-group><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Number of children enrolled reporting diarrhea within the previous 2 weeks and MSD within the previous 2 weeks by age group</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="2" colspan="1">Age stratum (months)</th><th align="center" rowspan="2" colspan="1">Enrolled (<italic>n</italic>)</th><th align="center" colspan="2" rowspan="1">Diarrhea in previous 2 weeks</th><th align="center" colspan="2" rowspan="1">MSD in previous 2 weeks</th></tr><tr><th align="center" rowspan="1" colspan="1"><italic>N</italic></th><th align="center" rowspan="1" colspan="1">Percent (weighted)</th><th align="center" rowspan="1" colspan="1"><italic>b</italic></th><th align="center" rowspan="1" colspan="1">Percent (weighted)</th></tr></thead><tbody><tr><td rowspan="1" colspan="1">0–11</td><td rowspan="1" colspan="1">246</td><td rowspan="1" colspan="1">44</td><td rowspan="1" colspan="1">18</td><td rowspan="1" colspan="1">26</td><td rowspan="1" colspan="1">11</td></tr><tr><td rowspan="1" colspan="1">12–23</td><td rowspan="1" colspan="1">363</td><td rowspan="1" colspan="1">56</td><td rowspan="1" colspan="1">15</td><td rowspan="1" colspan="1">37</td><td rowspan="1" colspan="1">10</td></tr><tr><td rowspan="1" colspan="1">24–59</td><td rowspan="1" colspan="1">391</td><td rowspan="1" colspan="1">26</td><td rowspan="1" colspan="1">7</td><td rowspan="1" colspan="1">16</td><td rowspan="1" colspan="1">4</td></tr><tr><td rowspan="1" colspan="1">Combined</td><td rowspan="1" colspan="1">1,000</td><td rowspan="1" colspan="1">126</td><td rowspan="1" colspan="1">12</td><td rowspan="1" colspan="1">79</td><td rowspan="1" colspan="1">7</td></tr></tbody></table></table-wrap><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Background and household characteristics of children in the HUAS study population, Bamako, 2007 (<italic>N</italic> = 1,000)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="2" colspan="1">Characteristic</th><th align="center" colspan="2" rowspan="1">All interviewed (<italic>N</italic> = 1,000)</th><th align="center" colspan="2" rowspan="1">Children with diarrhea in the preceding 2 weeks (<italic>N</italic> = 126)</th></tr><tr><th align="center" rowspan="1" colspan="1"><italic>n</italic>/<italic>N</italic></th><th align="center" rowspan="1" colspan="1">Percent<xref ref-type="table-fn" rid="TFN1">*</xref></th><th align="center" rowspan="1" colspan="1"><italic>n</italic>/<italic>N</italic></th><th align="center" rowspan="1" colspan="1">Percent<xref ref-type="table-fn" rid="TFN1">*</xref></th></tr></thead><tbody><tr><td colspan="5" rowspan="1">Age stratum (months)</td></tr><tr><td rowspan="1" colspan="1"> 0–11</td><td rowspan="1" colspan="1">246</td><td rowspan="1" colspan="1">25</td><td rowspan="1" colspan="1">44</td><td rowspan="1" colspan="1">35</td></tr><tr><td rowspan="1" colspan="1"> 12–23</td><td rowspan="1" colspan="1">363</td><td rowspan="1" colspan="1">36</td><td rowspan="1" colspan="1">56</td><td rowspan="1" colspan="1">44</td></tr><tr><td rowspan="1" colspan="1"> 24–59</td><td rowspan="1" colspan="1">391</td><td rowspan="1" colspan="1">39</td><td rowspan="1" colspan="1">26</td><td rowspan="1" colspan="1">21</td></tr><tr><td rowspan="1" colspan="1">Female sex</td><td rowspan="1" colspan="1">508</td><td rowspan="1" colspan="1">51</td><td rowspan="1" colspan="1">58</td><td rowspan="1" colspan="1">46</td></tr><tr><td rowspan="1" colspan="1">Primary caretaker is a parent</td><td rowspan="1" colspan="1">926</td><td rowspan="1" colspan="1">93</td><td rowspan="1" colspan="1">121</td><td rowspan="1" colspan="1">96</td></tr><tr><td rowspan="1" colspan="1">Mother lives in household</td><td rowspan="1" colspan="1">961</td><td rowspan="1" colspan="1">96</td><td rowspan="1" colspan="1">123</td><td rowspan="1" colspan="1">98</td></tr><tr><td rowspan="1" colspan="1">Father lives in household</td><td rowspan="1" colspan="1">72</td><td rowspan="1" colspan="1">83</td><td rowspan="1" colspan="1">97</td><td rowspan="1" colspan="1">77</td></tr><tr><td rowspan="1" colspan="1">Primary caretaker completed primary school or above</td><td rowspan="1" colspan="1">169</td><td rowspan="1" colspan="1">17</td><td rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1">16</td></tr><tr><td rowspan="1" colspan="1">Median number (range) of people living in household for past 6 months</td><td colspan="2" rowspan="1">13 (3–100)</td><td colspan="2" rowspan="1">13 (3–90)</td></tr><tr><td rowspan="1" colspan="1">Median number (range) of rooms in house for sleeping</td><td colspan="2" rowspan="1">4 (1–82)</td><td colspan="2" rowspan="1">4 (1–18)</td></tr><tr><td rowspan="1" colspan="1">Median number (range) of children ages < 60 months living in house</td><td colspan="2" rowspan="1">2 (1–14)</td><td colspan="2" rowspan="1">2 (1–14)</td></tr></tbody></table><table-wrap-foot><fn id="TFN1"><label>*</label><p>Unweighted.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T3" position="float"><label>Table 3</label><caption><p>Proportion of children with MSD seeking care from an SHC</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="2" colspan="1">HUAS round</th><th align="center" rowspan="2" colspan="1">Start</th><th align="center" rowspan="2" colspan="1">End</th><th align="center" rowspan="2" colspan="1">< 5 Years population</th><th align="center" rowspan="2" colspan="1">Interviewed</th><th align="center" colspan="2" rowspan="1">Diarrhea in previous 2 weeks</th><th align="center" colspan="2" rowspan="1">Diarrhea taken to SHC</th><th align="center" colspan="2" rowspan="1">MSD in previous 2 weeks</th><th align="center" colspan="2" rowspan="1">MSD taken to SHC</th></tr><tr><th align="center" rowspan="1" colspan="1"><italic>n</italic></th><th align="center" rowspan="1" colspan="1">Percent (95% CI)</th><th align="center" rowspan="1" colspan="1"><italic>n</italic></th><th align="center" rowspan="1" colspan="1">Percent (95% CI)</th><th align="center" rowspan="1" colspan="1"><italic>n</italic></th><th align="center" rowspan="1" colspan="1">Percent (95% CI)</th><th align="center" rowspan="1" colspan="1"><italic>n</italic></th><th align="center" rowspan="1" colspan="1">Percent (95% CI)</th></tr></thead><tbody><tr><td rowspan="1" colspan="1">Original</td><td rowspan="1" colspan="1">3/9/07</td><td rowspan="1" colspan="1">5/12/07</td><td rowspan="1" colspan="1">33,220</td><td rowspan="1" colspan="1">1,000</td><td rowspan="1" colspan="1">126</td><td rowspan="1" colspan="1">12 (10–14)</td><td rowspan="1" colspan="1">28</td><td rowspan="1" colspan="1">21.2 (14–29)</td><td rowspan="1" colspan="1">79</td><td rowspan="1" colspan="1">7 (6–9)</td><td rowspan="1" colspan="1">24</td><td rowspan="1" colspan="1">30 (19–41)</td></tr><tr><td rowspan="1" colspan="1">Lite 1</td><td rowspan="1" colspan="1">2/24/09</td><td rowspan="1" colspan="1">9/3/09</td><td rowspan="1" colspan="1">31,923</td><td rowspan="1" colspan="1">1,016</td><td rowspan="1" colspan="1">185</td><td rowspan="1" colspan="1">14.8 (13–17)</td><td rowspan="1" colspan="1">22</td><td rowspan="1" colspan="1">12 (6–17)</td><td rowspan="1" colspan="1">94</td><td rowspan="1" colspan="1">7 (6–9)</td><td rowspan="1" colspan="1">17</td><td rowspan="1" colspan="1">16 (9–24)</td></tr><tr><td rowspan="1" colspan="1">Lite 2</td><td rowspan="1" colspan="1">11/10/09</td><td rowspan="1" colspan="1">5/31/10</td><td rowspan="1" colspan="1">32,526</td><td rowspan="1" colspan="1">1,001</td><td rowspan="1" colspan="1">157</td><td rowspan="1" colspan="1">12.1 (10–14)</td><td rowspan="1" colspan="1">24</td><td rowspan="1" colspan="1">13 (8–18)</td><td rowspan="1" colspan="1">67</td><td rowspan="1" colspan="1">5 (4–6)</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">18 (9–27)</td></tr><tr><td rowspan="1" colspan="1">Lite 3</td><td rowspan="1" colspan="1">8/8/10</td><td rowspan="1" colspan="1">1/15/11</td><td rowspan="1" colspan="1">32,014</td><td rowspan="1" colspan="1">998</td><td rowspan="1" colspan="1">164</td><td rowspan="1" colspan="1">13.1 (11–15)</td><td rowspan="1" colspan="1">19</td><td rowspan="1" colspan="1">10 (5–16)</td><td rowspan="1" colspan="1">79</td><td rowspan="1" colspan="1">6 (4–8)</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">16 (6–25)</td></tr><tr><td rowspan="1" colspan="1">Combined<xref ref-type="table-fn" rid="TFN2">*</xref></td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">–</td><td rowspan="1" colspan="1">3,013</td><td rowspan="1" colspan="1">506</td><td rowspan="1" colspan="1">13 (12–15)</td><td rowspan="1" colspan="1">65</td><td rowspan="1" colspan="1">12 (9–15)</td><td rowspan="1" colspan="1">240</td><td rowspan="1" colspan="1">6 (5–7)</td><td rowspan="1" colspan="1">45</td><td rowspan="1" colspan="1">17 (12–22)</td></tr></tbody></table><table-wrap-foot><fn id="TFN2"><label>*</label><p>Combined is for HUAS-lite rounds only.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T4" position="float"><label>Table 4</label><caption><p>Multivariate weighted logistic regression showing factors associated with reported diarrheal illness within the previous 14 days among children < 5 years old in the HUAS, Bamako, 2007 (<italic>N</italic> = 1,000)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1">Variable</th><th align="center" rowspan="1" colspan="1">Adjusted OR</th><th align="center" rowspan="1" colspan="1">95% CI</th></tr></thead><tbody><tr><td rowspan="1" colspan="1">Age (months), less than 9 months</td><td rowspan="1" colspan="1">1.31</td><td rowspan="1" colspan="1">1.10–1.56</td></tr><tr><td rowspan="1" colspan="1">Age (months), 9 months and over</td><td rowspan="1" colspan="1">0.94</td><td rowspan="1" colspan="1">0.92–0.96</td></tr><tr><td rowspan="1" colspan="1">Female</td><td rowspan="1" colspan="1">0.78</td><td rowspan="1" colspan="1">0.51–1.20</td></tr><tr><td rowspan="1" colspan="1">Wealth index (highest two quintiles)</td><td rowspan="1" colspan="1">0.60</td><td rowspan="1" colspan="1">0.38–0.95</td></tr><tr><td rowspan="1" colspan="1">Children < 60 months old living in the household</td><td rowspan="1" colspan="1">1.02</td><td rowspan="1" colspan="1">1.01–1.20</td></tr><tr><td rowspan="1" colspan="1">Caretaker had no education (compared with religious, primary, secondary, or post-secondary)</td><td rowspan="1" colspan="1">0.61</td><td rowspan="1" colspan="1">0.39–0.95</td></tr><tr><td rowspan="1" colspan="1">Caretaker knows ways to prevent the child from getting simple loose/watery diarrhea</td><td rowspan="1" colspan="1">0.34</td><td rowspan="1" colspan="1">0.20–0.58</td></tr><tr><td rowspan="1" colspan="1">Caretaker believes nutrition is one of the best ways to prevent diarrhea</td><td rowspan="1" colspan="1">1.89</td><td rowspan="1" colspan="1">1.08–3.31</td></tr></tbody></table></table-wrap><table-wrap id="T5" position="float"><label>Table 5</label><caption><p>Care-seeking behavior among caretakers with children with diarrhea in the HUAS study population, Bamako, 2007 (<italic>N</italic> = 96)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="2" colspan="1">Characteristic: Type of care sought</th><th align="center" colspan="2" rowspan="1">Caretaker who sought care for child with diarrhea in the preceding 2 weeks (<italic>N</italic> = 96)</th></tr><tr><th align="center" rowspan="1" colspan="1"><italic>n</italic></th><th align="center" rowspan="1" colspan="1">Weighted (%)</th></tr></thead><tbody><tr><td rowspan="1" colspan="1">Pharmacy</td><td rowspan="1" colspan="1">16</td><td rowspan="1" colspan="1">17</td></tr><tr><td rowspan="1" colspan="1">Friend/relative</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">0</td></tr><tr><td rowspan="1" colspan="1">Traditional healer</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1">57</td></tr><tr><td rowspan="1" colspan="1"> Before seeking care at GHC</td><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">5</td></tr><tr><td rowspan="1" colspan="1"> Without seeking care at GHC</td><td rowspan="1" colspan="1">45</td><td rowspan="1" colspan="1">48</td></tr><tr><td rowspan="1" colspan="1">Unlicensed practitioner<xref ref-type="table-fn" rid="TFN3">*</xref></td><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">5</td></tr><tr><td rowspan="1" colspan="1">Licensed practitioner/private doctor (not at a hospital)</td><td rowspan="1" colspan="1">3</td><td rowspan="1" colspan="1">2</td></tr><tr><td rowspan="1" colspan="1">Bought remedy in shop/market</td><td rowspan="1" colspan="1">10</td><td rowspan="1" colspan="1">11</td></tr><tr><td rowspan="1" colspan="1">GHC</td><td rowspan="1" colspan="1">28</td><td rowspan="1" colspan="1">27</td></tr></tbody></table><table-wrap-foot><fn id="TFN3"><label>*</label><p>Unlicensed practitioner/village doctor/bush doctor/village health worker.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T6" position="float"><label>Table 6</label><caption><p>Multivariate weighted logistic regression showing factors associated with seeking care from a traditional healer (versus all other sources of care) for reported diarrheal illness within the previous 14 days among children < 5 years old in the HUAS, Bamako, 2007 (<italic>N</italic> = 96)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1">Variable</th><th align="center" rowspan="1" colspan="1">Adjusted OR</th><th align="center" rowspan="1" colspan="1">95% CI</th></tr></thead><tbody><tr><td colspan="3" rowspan="1">Signs/symptoms</td></tr><tr><td rowspan="1" colspan="1"> Caretaker thought that the child had decreased urination</td><td rowspan="1" colspan="1">3.35</td><td rowspan="1" colspan="1">1.19–9.41</td></tr><tr><td rowspan="1" colspan="1"> Caretaker reported mucus or pus in the stool</td><td rowspan="1" colspan="1">4.42</td><td rowspan="1" colspan="1">1.35–14.51</td></tr><tr><td colspan="3" rowspan="1">Beliefs</td></tr><tr><td rowspan="1" colspan="1"> Caretaker thinks wrinkled skin is a sign of dehydration</td><td rowspan="1" colspan="1">0.14</td><td rowspan="1" colspan="1">0.04–0.52</td></tr><tr><td rowspan="1" colspan="1"> Caretaker thinks coma is a sign of dehydration</td><td rowspan="1" colspan="1">10.37</td><td rowspan="1" colspan="1">1.10–98.41</td></tr><tr><td rowspan="1" colspan="1"> Caretaker thinks thirst is a sign of dehydration</td><td rowspan="1" colspan="1">3.55</td><td rowspan="1" 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