Objectives. We identified barriers to care seeking for pneumonia and diarrhea
among rural Guatemalan children.
Methods. A population-based survey was conducted twice from 2008 to 2009
among 1605 households with children younger than 5 years. A 14-day calendar
recorded episodes of carer-reported pneumonia (n = 364) and diarrhea (n = 481),
and formal (health services, public, private) and informal (neighbors, traditional,
local shops, pharmacies) care seeking.
Results. Formal care was sought for nearly half of severe pneumonias but only
for 27% within 2 days of onset, with 31% and 18%, respectively, for severe
diarrhea. In multivariable analysis, factors independently associated with formal
care seeking were knowing the Community Emergency Plan, mother’s perception
of illness severity, recognition of World Health Organization danger signs,
distance from the health center, and having someone to care for family in an
emergency.
Conclusions. Proximal factors associated with recognizing need for care were
important in determining formal care, and were strongly linked to social
determinants. In addition to specific action by the health system with an
enhanced community health worker role, a systems approach can help ensure
barriers are addressed among poorer and more remote homes.