Drivers of delayed care-seeking among children aged 6–35 months with medically-attended diarrhea: Findings from the Enterics for Global Health (EFGH)-Shigella surveillance study, 2022–2024

Timely healthcare seeking is critical to reducing preventable deaths from childhood diarrhea. We examined host, clinical, and sociodemographic factors associated with delayed seeking for medically-attended diarrhea (MAD) among children aged 6–35 months in the Enterics for Global Health (EFGH) study. We conducted a cross-sectional analysis among children aged 6–35 months enrolled in the EFGH study with MAD from Bangladesh, The Gambia, Kenya, Malawi, Mali, Pakistan, and Peru. Delayed care seeking was defined as presenting to a study facility ≥2 days after diarrhea onset; a sensitivity analysis used ≥4 days. Prevalence of delayed care-seeking was 61.7% across study sites. Delays were common among younger children, younger caregivers, those who sought prior care, and those presenting with severe illness. Children aged 12–23 months (aPR = 0.96; 95% CI: 0.93–0.99) and 24–35 months (aPR = 0.90; 95% CI: 0.86–0.94) were less likely to experience delays compared to those aged 6–11 months. Caregivers aged 20–29 years (aPR = 0.92; 95% CI: 0.88–0.96) and 30–39 years (aPR = 0.91; 95% CI: 0.86–0.95) were also less likely to delay compared to caregivers under 20 years. Prior care-seeking was strongly associated with delay, including visits to medical providers (aPR = 1.29; 95% CI: 1.23–1.35), community health workers (aPR = 1.25; 95% CI: 1.13–1.38), pharmacies (aPR = 1.21; 95% CI: 1.15–1.27), and traditional healers (aPR = 1.29; 95% CI: 1.19–1.40). Indicators of clinical severity were also linked to delay, including some dehydration (aPR = 1.08; 95% CI: 1.03–1.13), dysentery (aPR = 1.15; 95% CI: 1.11–1.20), and severe Modified Vesikari Score (aPR = 1.13; 95% CI: 1.09–1.18). Delayed healthcare seeking for childhood diarrhea is common in high-burden LMIC settings and varies substantially by country.