Medical Care Utilization

This paper describes the use-pattern of medical care prior to death caused by cholera outbreaks in rural Bangladesh. In nine rural communities 92 acute diarrhoeal deaths were recorded. These mainly occurred within 24 hours or less of diarrhoea onset, and were time-clustered. An on-the-spot stool culture survey of active cases confirmed cholera cases. In 50% of deaths, diarrhoea onset occurred between midnight and 9 am. Fifty-one percent of the fatalities had been treated earlier by village practitioners, another 20% had been attended by qualified doctors, and 8% had had no medical care. Oral rehydration therapy alone had been used in 29 cases, but 26 died within 24 hours. Of 43 persons who received intravenous therapy, oral rehydration and antibiotics, 21 (45%) died within 24 hours and 12 (28%) after 48 hours. Seventeen deceased had received no rehydration therapy. Early and adequate fluid therapy is required for optimal rehydration. Training of community people and health personnel, along with resources mobilization, will save lives by preventing unnecessary dehydration deaths.