Basic Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. Aug 25, 2017; 7(3): 38-45
Published online Aug 25, 2017. doi: 10.5495/wjcid.v7.i3.38
Healthcare seeking trends in acute respiratory infections among children of Pakistan
Hana Mahmood, Samina Mohsin Khan, Saleem Abbasi, Yahya Sheraz
Hana Mahmood, International Research Force/Maternal, Neonatal and Child Health Research Network (MNCHRN), Islamabad 44000, Pakistan
Samina Mohsin Khan, ARI Research Cell, Children Hospital, Pakistan Institute of Medical Sciences (PIMS), and Training/Research Coordinator, Department of Public Health, Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad 44000, Pakistan
Saleem Abbasi, MNCHRN and ARI Research Cell, Children Hospital, PIMS, SZABMU, Islamabad 44000, Pakistan
Yahya Sheraz, International Research Force, Islamabad 44000, Pakistan
Author contributions: Mahmood H, Khan SM and Abbasi S contributed equally to this work; Mahmood H, Khan SM and Abbasi S conceived the study and designed methodology; Mahmood H and Abbasi S performed the research; Mahmood H, Abbasi S and Sheraz Y wrote the paper; Khan SM supervised the research and edited the manuscript which was approved by all.
Institutional review board statement: The study was reviewed and approved by the Shaheed Zulfiqar Ali Bhutto Medical University Institutional Review Board.
Institutional animal care and use committee statement: No animals were used or harmed in this research as it is a sub analysis of secondary data from available database of 2006-07 and 2012-13 Demographic Health Surveys of Pakistan.
Conflict-of-interest statement: The authors listed in the manuscript certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The signed statement is attached herewith.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at Considering this is subanalysis of secondary data obtained through demographic health surveys (DHS), therefore the National Institute of Population Studies collected data after seeking consent from the participants and we have sought permission from the custodian organization of DHS for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Hana Mahmood, Project Director, International Research Force/Maternal, Neonatal and Child Health Research Network, Plot 21, Scheme 1, National Park Area, Lehtrar Road, Tarlai, Islamabad 44000, Pakistan.
Telephone: +92-300-9775669
Received: September 28, 2016
Peer-review started: October 7, 2016
First decision: November 14, 2016
Revised: November 29, 2016
Accepted: February 10, 2017
Article in press: February 12, 2017
Published online: August 25, 2017

To assess healthcare seeking trends among Pakistani children with acute respiratory infections through comparative analysis between demographic health surveys (DHS) 2006-2007 and 2012-2013.


Data of the last born children 0-24 mo of age of the sampled households from both the DHS was analyzed after seeking permission from the DHS open access website. These were children who had suffered from cough and/or breathing difficulty in the past two weeks and sought health care thereafter. The trends of health care seeking were determined separately for the individual, household and community level according to the study parameters. χ2 test was applied to compare these trends. A P-value of < 0.05 was considered significant.


Out of 2508 children in 2006-2007 there were 1590 with acute respiratory infections (ARI) according to case definition along with 2142 out of 3419 children in 2012-2013 DHS, whose data was analyzed. During 2006-2007, 69% cases sought healthcare for ARI which improved to 79% in 2012-2013. Additionally, it was revealed that when compared between 2006-2007 and 2012-2013, improvement in care seeking practices was observed among illiterate mothers (64% vs 77%) although there was minimal change in those literate. Similarly, those women working also showed an increase in healthcare seeking from 67% to 79%. Additionally, those belonging to low and middle socioeconomic class showed a marked increase as compared to those in the higher class where there was no significant change. Whereas those living in rural communities also showed an increase from 66% to 78%.


Increasing health budget, improving maternal education and strengthening multi-sectoral coordination are among the effective strategies to improve outcomes associated with healthcare seeking in ARI.

Keywords: Acute respiratory infections, Demographic health surveys, Comparison, Pneumonia, Healthcare seeking

Core tip: Acute respiratory infections (ARI) contribute to childhood morbidity and mortality due to poor healthcare seeking among other causes. We aimed to identify the healthcare seeking trends among Pakistani children with ARI through comparative analysis between DHS 2006-2007 and 2012-2013. Data of last born children 0-24 mo was analyzed. In 2006-2007, 69% cases sought healthcare which improved to 79% in 2012-2013. Improvement was observed among poor, illiterate mothers, those working, and/or living in rural communities. It is therefore, important to develop strategies and interventions focusing on this category of caretakers to improve the outcome associated with ARI.