Maternal behavior and experience, care access, and agency as determinants of child diarrhea in Bolivia.

OBJECTIVE: In Latin America and the Caribbean, Bolivia has the third highest rate of mortality among children under five years of age (57 per 1 000), with 14.0% of under-five deaths attributable to diarrhea. Because a child's world is predominantly controlled by and experienced through his or her mother, this investigation aims to understand what maternal dimensions may determine child diarrhea. METHODS: Variables were selected from the 2003 Bolivia Demographic and Health Survey to create indices of three maternal dimensions using principal components analysis: behavior and experience, access to care, and agency. The three indices were included in a logistic regression model while controlling for economic status, maternal education, and residence type. RESULTS: A total of 4 383 women who had children less than 5 years old were included in the final sample and 25.0% of mothers reported that their most recent born child had experienced an episode of diarrhea in the 2 weeks before the survey. Mothers with high levels of maternal agency or of high economic status were significantly less likely to report their child experienced an episode of diarrhea than women of low levels. Women with primary education were significantly more likely to report that their child experienced diarrhea than women with no education. CONCLUSIONS: High levels of agency have a significant protective effect even when controlling for other factors. Increasing maternal agency could have a positive impact on child health in Bolivia, and future work should aim to understand what accounts for different levels of agency and how it may be strengthened.