Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Virginia Pitzer

Second Advisor

Ernest Asare

Abstract

Healthcare-seeking behavior (HSB) for childhood diarrhea is a central but persistently uncertain input for rotavirus burden models and vaccine cost-effectiveness analyses. Demographic and Health Surveys (DHS) provide the only nationally representative measurements, yet they are expensive and absent from the majority of low- and middle-income countries (LMICs). This thesis asks whether publicly available country-level indicators can substitute for DHS data when survey estimates are unavailable.Using the most recent DHS conducted between 2011 and 2024 in 51 LMICs (78,008 children under five with diarrhea), I fit a multilevel modified Poisson regression and a two-stage random-effects meta-regression with four World Bank moderators: health expenditure, education expenditure, urbanization, and GDP per capita. Pooled HSB prevalence was 45.5% (95% CI 41.4–49.7%) with extreme between-country heterogeneity (I² = 98.7%). Antenatal care, postnatal checkups, and maternal education were the most robust individual-level predictors. The four moderators jointly explained 18.4% of between-country heterogeneity, with health expenditure emerging as the only individually significant moderator. Calibration was modest but unbiased (R² = 0.262, MAE ≈ 9.7 percentage points). The mature insight is that the allocation of national resources toward health, not overall economic output, is the country-level lever most consistently associated with care-seeking. The meta-regression yields HSB estimates with quantified uncertainty for 112 LMICs, including those without recent DHS data. This can serve as a transparent default input for disease burden and cost-effectiveness models.

Comments

This is an Open Access Thesis.

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