Gaps in Healthcare Seeking for Childhood Diarrhea Among Peruvian Children Under Five Years of Age: Socioeconomic and Clinical Patterns in a National Survey

Abstract

Background: Childhood diarrhea remains a preventable public health problem, but gaps persist in contact with external care and receipt of effective treatment. Methods: We estimated the prevalence of non-use of external care for recent diarrhea among Peruvian children aged 0–59 months during 2019–2024 and examined associated clinical, maternal, socioeconomic, and territorial factors. We analyzed repeated cross-sectional ENDES microdata using survey-weighted modified Poisson regression with Taylor-linearized variance, year-specific primary sampling units, and strata. Results: Among 11,942 child-level survey observations with classifiable care-seeking information, non-use of external care was 43.5% (95% CI: 42.2–44.8); restrictive formal care seeking was 33.1%, and 23.4% (95% CI: 22.3–24.5) used only non-formal external sources. Among observations with valid treatment-specific information, 34.3% received oral rehydration salts, 1.0% zinc, and 0.5% both. Blood in stool was associated with lower non-use (aPR = 0.52; 95% CI: 0.42–0.63), whereas age 48–59 months was associated with higher non-use than age 0–11 months (aPR = 1.20; 95% CI: 1.08–1.33). The poorest quintile had modestly higher non-use than the richest quintile (aPR = 1.20; 95% CI: 1.03–1.41). Non-use was not associated with diarrhea still active at interview in the prespecified secondary model (PR = 0.99; 95% CI: 0.87–1.12). Conclusions: More than two in five recent episodes had no external care contact, and therapeutic coverage remained limited, particularly for zinc.