RESUMO
To describe the pattern and determinants of health services utilization in case of childhood diarrhea. A cohort of 257 infants, aged 0-9 months was selected from a semi-urban area in Assiut, Egypt, followed up for 12 months from October 1999 to October 2000. Diarrhoeal morbidity data was collected biweekly. Initially a baseline household survey was conducted to collect baseline data on the sociodemographic background of the family and the household environment. When diarrhoea was reported in a child, the mother was asked a standard series of questions on her child's stool frequency, consistency associated symptoms, perception of severity of the attack, her behavior toward her child ot home, the use of health care services, type of provider used and perception of quality of care. Utilization of health services was categorized into outpatient visits; emergency care visits, and hospital admissions. In 53.1% of diarrhoeal episodes mothers sought a health care provider outside the house; mainly from outpatient clinics [87.5%]. Emergency services were used in 7.1% of the episodes and hospital admission occurred in 5.4%. Multivariate analysis revealed that mothers' perception of severity of their children's diarrhoeal episodes held the major determinant for utilization of health services [OR=13.09, P=0.000]. Other determinants of using health services during diarrhoea included factors related to episode characteristics as presence of vomiting [OR=3.1. P=0.000] or fever [OR=2.63, P=0.000] and using of self-prescribing drugs [OR=0.224, P=0.000] for treatment of the episode at home. Mothers also sought medical care for younger infants than older ones [OR=2.42, P=0.001]. No association between utilization of health services and socioeconomic factors was found. Health services utilization in case of childhood diarrhoea interact with multiple factors, but mothers' perception of their children's health status during diarrhoea held the major influence on the utilization of health services. Furthermore, public health services were the most frequent type of services utilized for treatment of diarrhoea