Page et al. BMC Public Health 2011, 11:389 http://www.biomedcentral.com/1471-2458/11/389 R E S E A R C H A R T I C L E Open Access Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross- sectional survey Anne-Laure Page1*, Sarah Hustache1, Francisco J Luquero1, Ali Djibo2, Mahamane Laouali Manzo3 and Rebecca F Grais1 Abstract Background: Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases. Methods: A cluster survey was done on 35 clusters of 21 children under 5 years of age in each of four districts of the Maradi Region, Niger. Caretakers were asked about diarrhea of the child during the recall period and their health seeking behavior in case of diarrhea. A weighted cluster analysis was conducted to determine the prevalence of diarrhea, as well as the proportion of consultations and types of health structures consulted. Results: In total, the period prevalence of diarrhea and severe diarrhea between April 24th and May 21st 2009 were 36.8% (95% CI: 33.7 - 40.0) and 3.4% (95% CI: 2.2-4.6), respectively. Of those reporting an episode of diarrhea during the recall period, 70.4% (95% CI: 66.6-74.1) reported seeking care at a health structure. The main health structures visited were health centers, followed by health posts both for simple or severe diarrhea. Less than 10% of the children were brought to the hospital. The proportion of consultations was not associated with the level of education of the caretaker, but increased with the number of children in the household. Conclusions: The proportion of consultations for diarrhea cases in children under 5 years old was higher than those reported in previous surveys in Niger and elsewhere. Free health care for under 5 years old might have participated in this improvement. In this type of decentralized health systems, the WHO recommended hospital- based surveillance of severe diarrheal diseases would capture only a fraction of severe diarrhea. Lower levels of health structures should be considered to obtain informative data to ensure appropriate care and burden estimates. Background Although better sanitation, hygiene and access to care have successfully alleviated the burden of diarrheal dis- eases in developed countries [1,2], diarrhea remains the second leading cause of death in children under 5 years of age in the world, representing nearly one in five child deaths - about 1.5 million each year [3,4]. In sub- Saharan Africa, the etiology of diarrhea is seldom * Correspondence: anne-laure.page@epicentre.msf.org 1Epicentre, Paris, France Full list of author information is available at the end of the article known due to the lack of infrastructure for diagnosis. Further, improved hygiene has not had a major impact on some causes of diarrheal diseases, such as rotavirus, for which vaccination is now the recommended preven- tion strategy [5-7]. As rotavirus vaccines have become available, considerable efforts have been made to docu- ment the burden of severe rotavirus diarrhea with recent focus on Asia and Africa through the Asian and African Rotavirus Networks [8-11]. Despite these efforts, knowl- edge about the disease burden as well as the circulating strains is still lacking in many countries, such as Niger © 2011 Page et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.