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Factors affecting womens choices of health care providers for their childrenin rural and semi-urban Guatemala and its effect on childhood mortality

Objective



GUATEMALA IS A MULTIETHNIC AND MULTICULTURAL SOCIETY WHERE APPROXIMATELY HALF 0F ITS EIGHT MILLION INHABITANTS ARE INDIGENAS. AVAILABLE DATA INDICATE THAT UNDER-FIVE MORTALITY STILL EXCEEDS 150/1000 IN MANY RURAL COMMUNITIES, AND THAT DEATHS AMONG CHILDREN UNDER FIVE YEARS CONSTITUTE MORE THAN HALF OF ALL DEATHS IN THESE COMMUNITIES. GOVERNMENT HEALTH SERVICES HAVE BEEN EXPANDED CONSIDERABLY DURING THE LAST 10-15 YEARS IN RURAL GUATEMALA, BUT THE GOVERNMENT HEALTH SERVICES ARE PLANNED CENTRALLY, AND THE ATTENDANCE RATE AT MOST GOVERNMENT HEALTH FACILITIES IS VERY LOW IN RURAL AREAS. MORE THAN 50% 0F ALL DEATHS OCCUR WITHOUT ANY PRIOR ATTENTION 0F TRAINED MEDICAL PERSONNEL. LAY PRACTITINERS (TRADITIONAL AND MODERN) HAVE A MAJOR ROLE IN RURAL GUATEMALA. IN A RECENT OUTBREAK 0F MEASLES, A CASE FATALITY RATE 0F 2% WAS FOUND AMONG CHILDREN WHO RECEIVED MODERN MEDICAL ATTENTION, BUT THE CASE FATALITY RATE WAS ESTIMATED To BE ABOVE 20% AMONG THOSE CHILDREN WHO WERE SEEN BY LAY PRACTITIONERS ONLY. APPROXIMATELY HALF 0F THE CHILDREN WERE SEEN BY LAY PRACTITIONERS ONLY. IN THIS EPIDEMIC MODERN MEDICAL SERVICES WERE READILY AVAILABLE AND ACTIVELY PROMOTED. IT IS TO BE EXPECTED THAT A SIMILAR PATTERN WILL BE SEEN DURING THE CHOLERA EPIDEMIC, WHICH HAS JUST COMMENCED IN GUATEMALA. THIS STUDY, IN THE REALM 0F HEALTH SERVICES RESEARCH, IS EXPECTED To PROVIDE UNDERSTANDING OF THE FACTORS WHICH DETERMINE WOMENS HEALTH CARE BEHAVIOUR WHEN THEIR CHILDREN GET SICK IN RURAL AND SEMI-URBAN AREAS IN GUATEMALA, WHOM Do THEY SEE WHEN THEIR CHILDREN GET SICK AND WHY ? THIS IS PREREQUISITE FOR A REFORM BASED 0N DECENTRALIZATION IN A HEALTH CARE SYSTEM WHICH So FAR HAS PROVEN ITS FAILURE. IT IS ONE HYPOTHESIS THAT A MAJOR REASON WHY MANY CHILDREN Do NOT RECEIVE PROFESSIONAL CARE WHEN THEY ARE SICK IS BECAUSE THERE ARE NO LINKS BETWEEN LAY AND PROFESSIONAL HEALTH CARE PROVIDERS (AND THERE IS NO RECOGNITION FROM EITHER SIDE). EACH GROUP IS ENTRENCHED IN ITS FOXHOLES. THE SECOND PART OF THE PROJECT WILL BRING PROFESSIONAL AND LAY HEALTH CARE WORKERS TOGETHER THROUGH A PILOT TRAINING PROGRAMME WITH THE OBJECTIVE THAT THEY UNDERSTAND THE LIMITATIONS OF THEIR OWN SKILLS, LEARNING TO REFER PATIENTS BOTH WAYS' THE EFFECT OF THIS INTERVENTION WILL BE EVALUATED DURING THE PROJECT.

Funding Scheme

CSC - Cost-sharing contracts

Coordinator

Statens Serum Institut
Address
5,Artillerivej
2300 København
Denmark

Participants (2)

INSTITUTE OF TROPICAL MEDICINE PRINCE LEOPOLD
Belgium
Address
155,Nationalestraat 155
2000 Anvers /Antwerpen
Instituto Central de la Nutrición
Guatemala
Address
Carretera Rosevelt - Zona 11
01901 Guatemala