Energy, Air Pollution and Health Research


Energy and Health Equity

Improving child survival through enhanced understanding of barriers to health care access in rural Guatemala

Following on from our work with communities in the rural Guatemalan Highlands for the RESPIRE trial, we conducted a study investigating barriers to care seeking for pneumonia and diarrhoea among rural Guatemalan children and among pregnant women. A population-based survey was conducted twice from 2008 to 2009 among 1605 households with children younger than 5 years of age. A 14-day calendar recorded episodes of carer-reported pneumonia and diarrhoea, and formal (health services, public, private) and informal (neighbours, traditional healers, local shops, pharmacies) care seeking. Additional data collection included (i) interviews with women about pre-natal and maternal health, (ii) a survey of pregnant women about accessing health care and (iii) interviews with parents of sick children and whose children had died.

Conducting survey work to study care seeking for recent episodes of diarrhoea and pneumonia in young children, San Marco, Guatemala

The research found that proximal factors [including knowing the Community Emergency Plan, mother’s perception of illness severity, recognition of World Health Organization danger signs, distance from the health center, and having someone to care for family in an emergency] were independently associated with formal care seeking. We argue that, in addition to specific action by the health care system with an enhanced community health worker role, a systems approach can help ensure barriers are addressed among poorer and more remote homes.


The study was carried out in collaboration with The University del Valle, Guatemala (Dr Byron Arana). The study team form Liverpool involved Professor Nigel Bruce (PI), Dr Debbi Stanistreet (co-PI), Dr Daniel Pope (co-investigator), Dr Mukesh Dherani (researcher) and Christopher Shiels (data analysis).


UBS Optimus Foundation $200,000.

Publications/ dissemination

Bruce N, Pope D, Arana, B, Shiels C, Romero C, Stanistreet D. Help seeking for children with severe pneumonia and diarrhoea in rural Guatemala. Am J Public Health 2014; 104: 647-657.