Sociodemographic determinants of healthcare-seeking options and alternative management practices of childhood diarrheal illness: A household survey among mothers in Iraq

Diarrhea remains a significant cause of child morbidity and mortality in Iraq. The objective of this study was to examine the current practices of home-based management of diarrheal illnesses among Iraqi children. We surveyed mothers of children aged less than 5 years to identify the sociodemographic factors associated with maternal healthcare-seeking practices. A total of 500 mother-child pairs were interviewed in a cross-sectional household survey in Thi-Qar Governorate, southeastern Iraq, between March 2016 and February 2017. Logistic and multinomial regression models were used to infer sociodemographic predictors of the healthcare-seeking and alternative management practices adopted by the mothers. The interviewees reported that 35.2% of their children had diarrhea in the 2 weeks before the survey. The least likelihood of reported occurrence of diarrhea was among mother-child pairs where the mothers had received university education, as compared with mothers who were illiterate or received only primary or secondary education. Lower odds (odds ratio = 0.4, P-value < 0.001) of reported childhood diarrhea was revealed among mothers aged > 25 years than among those younger. Self-ordered medicine from a pharmacy was the most preferred alternative management option in almost half (52.4% [262/500]) of the interviewed mothers in Thi-Qar. Interestingly, 69.6% (348/500) of the mothers reported supplying their children suffering from diarrhea with antibiotics. Relative to mothers with university education, those with high school education had more likelihood of selecting medical center (relative risk ratio [rrr] = 2.4) and pharmacy (rrr = 3.7) as against no treatment. Lower maternal educational level, mothers' age < 25 years, and the district of residence were important factors associated with diarrhea occurrence among children younger than 5 years. In light of the findings from this study, intervention aimed at improving healthcare seeking for managing diarrhea in Iraqi children should jointly consider the influence of mothers age, education, as well as the level of economic status of the communities in which mothers of these children reside. The results of this study indicate the need for enhancing public health education to improve the maternal management of diarrheal disease and the avoidance of unnecessary use of antimicrobials.