REGULAR ARTICLE Why are there delays in seeking treatment for childhood diarrhoea in India? Nisha Malhotra 1 , Ravi Prakash Upadhyay (ravi.p.upadhyay@gmail.com) 2 1.Vancouver School of Economics, Faculty of Arts, University of British Columbia, Vancouver, BC, Canada 2.Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India Keywords Childhood diarrhoea, Delay, Gender Bias, ORS knowledge, Treatment seeking Correspondence Ravi Prakash Upadhyay, Senior Resident, Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India. Tel: +91 9911645513 | Fax: 011-26714819 | Email: ravi.p.upadhyay@gmail.com Received 28 March 2013; revised 13 May 2013; accepted 27 May 2013. DOI:10.1111/apa.12304 ABSTRACT Aim: To examine the barriers and facilitating factors for seeking treatment for childhood diarrhoea and to determine the main causes for delay in seeking treatment. Methods: Data from Indian Demographic and Health survey 2005–06 (NFHS-III) were used. Mothers were asked whether their children (<5-years) had suffered from diarrhoea during the 2 weeks preceding the survey. Data were collected on the time of seeking treatment after start of the illness and days waited to seek treatment after the diarrhoea started. Multivariate logistic regression analysis was performed to find the determinants of seeking treatment at the health facility and the factors responsible for the ‘delay’ in seeking advice/treatment. Results: Of a sample of 41 287 children, 3890 (9.4%) reportedly had diarrhoea. Sixty percentage of children with diarrhoea were taken to a health facility. Mother’s education till higher secondary and above (OR 1.65; 95% CI, 1.08–2.54), richest (OR 1.76; 95% CI, 1.24–2.48) wealth index, and possession of a health card by the mother (OR 1.35; 95% CI, 1.12–1.62) increased the odds of seeking treatment. There was a strong gender bias; a male child had lower odds of experiencing a ‘delay’ in seeking treatment, compared with a female child (OR 0.71; 95% CI, 0.55–0.92). Access to a health facility still remains a major issue: treatment seeking was delayed when distance to a health facility was reported as a ‘major problem’ (OR 1.33; 95% CI, 1.01–1.76). Conclusion(s): Improved care seeking for childhood diarrhoea in India is still constrained by access to a health facility and requires expansion and strengthening of the public health system. The caregivers, especially the mothers need to be educated about the importance of seeking timely treatment and the benefits of oral rehydration solution. INTRODUCTION The beginning of the 1980s saw approximately 4.6 million child deaths from diarrhoea which sparked the World Health Organization’s Programme for Control of Diarrho- eal Diseases (1). The primary danger from diarrhoea is severe dehydration, and repeated bouts can lead to death. Another concern is malnutrition from persistent diarrhoea predisposing the child to future bouts of enteric infections. Diarrhoea accounts for 11% of the total under-five deaths, which makes it the second leading cause of death in this age group (2,3). India alone contributes to nearly half a million diarrhoeal deaths globally (4,5). The majority of diarrhoea-related deaths can be pre- vented by early diagnosis, timely use of oral rehydration solution (ORS), continued feeding and utilization of qual- ified healthcare providers (3,6). Childhood diarrhoea is an important risk factor associated with child malnutrition, and India has among the highest child malnutrition rates in the world accounting for 42% of world’s underweight and 31% of world’s stunted children (7–12). Given the high rates of child malnutrition in the population, delays in seeking appropriate medical treatment for diarrhoea can prove to be fatal and could lead to adverse outcomes. Thus, it becomes essential for the caregivers to recognize the severity of the diarrhoeal episode and seek treatment at the earliest. According to the national family health survey (NFHS) -3, nationally, 9% of children under the age of 5 years Key notes  Treatment for childhood diarrhoea is often inappropri- ate and delayed.  There is a strong gender bias in seeking care for childhood diarrhoea with higher treatment delays for females.  Access to a health facility still remains a major issue in the treatment for childhood diarrhoea.  Mother’s lack of education and knowledge regarding Oral Rehydration Salts needs to be addressed for timely treatment of childhood diarrhoea. ©2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2013 102, pp. e413–e418 e413 Acta Pædiatrica ISSN 0803-5253