May 2010

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Objective: The present study seeks to obtain a better understanding of health-utilization patterns—particularly with regard to oral rehydration solutions (ORS) use—in response to diarrheal illness from data in two distinct regions of Guatemala. This study will provide information that health authorities may use to develop interventions aimed at reducing mortality associated with diarrhea, such as through targeted educational interventions to improve ORS use and household/community management of this common childhood illness in Guatemala. Methods: Data from a population-based, lab-enhanced surveillance system in Guatemala, Vigilancia Comunitaria (ViCo), were utilized in the present analysis. Trained ViCo staff from governmental health-care facilities in the Santa Rosa and Quetzaltenango Departments of Guatemala collected demographic, clinical, laboratory and health-behavior data from patients diagnosed with diarrhea. All data were collected using personal digital assistants (PDAs) after obtaining informed consent/assent from participants enrolled in the study. The present analyses include 3,044 patients who were admitted to hospitals and ambulatory clinics in Santa Rosa or Quetzaltenango with diarrhea. Statistical analyses were carried out using SAS 9.2®. Results: Sixty percent of patients who sought care at the public hospitals and ambulatory care centers in these two departments of Guatemala were considered to have had “moderate” cases of diarrheal illness. As anticipated, patients with more severe cases of illness were more likely to seek care at a hospital rather than an ambulatory care center, and children were more likely to be taken to the hospital for all levels of illness severity. Care-seeking patterns seemed to begin at local facilities, such as tiendas and pharmacies, where treatment could be purchased, but no clinicians were available to evaluate the patient. Almost half of all participants (42%) had used some form of treatment prior to enrollment in the study. Prevalence of ORS use among young children was low, approximately 32%, of which 61% knew how to prepare ORS packets properly. Those least likely to use ORS were: Quetzaltenango residents, indigenous Mayan, two to four years of age, mild illness symptoms, low SES, and had sought prior care at a tienda. The majority of users obtained ORS from pharmacies (47%) or government-sponsored ambulatory clinics (28%). Those who obtained ORS packets from tiendas or pharmacies were most likely to improperly prepare ORS for use compared with those who obtained ORS packets from an ambulatory clinic. Conclusion: In this population, ORS is low (32%) and care-seeking seems to begin at local pharmacies and tiendas. Those who obtain ORS packets from these facilities tend to use the ORS packets improperly. So, targeted educational interventions to community members, including these facilities, might increase the prevalence ORS use and improve the proper usage of ORS. The findings of this study suggest that further research looks at health utilization behaviors, especially ORS use, in the general community. Lessons learned from the present study in Guatemala provide a context for understanding factors associated with non-use and improper use of ORS in other countries around the world that are also burdened with a disproportionate level of diarrheal illness.




School of Medicine



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