In a household survey in Guinea-Bissau, 319 episodes of
diarrhea in children were followed by interviews every second day with the aim of investigating perceived morbidity and subsequent actions taken. The majority of the mothers had good knowledge of
oral rehydration salts (
ORS). However, only 58% of the episodes were treated with
ORS and the amount given was insufficient. Mothers with no knowledge of
ORS did not use it during the observed attack of
diarrhea regardless of contact with a health center, which suggests that maternal knowledge is an important determinant of whether health personnel provide
ORS. Children with
diarrhea considered to be caused by teething were less likely to receive
ORS in the acute phase (risk ratio = 0.6, 95% confidence interval [CI] = 0.5-0.9). Univariate analyses showed that the use of
ORS was related to number of reported symptoms, the mother being the care taker, consultations, previous use of
ORS, good knowledge of
ORS, and having
ORS sachets at home. Multivariate Cox regression analyses showed that the presence of
ORS sachets at home at the onset of
diarrhea was the strongest predictor of use (hazard ratio = 3.3, 95% CI = 1.9-3.6). Improved health education should focus more on the quantity of
ORS needed, early signs of
dehydration, treatment of teething
diarrhea, and breast feeding, and address mothers who have no prior knowledge of
ORS. Management of
diarrhea may be improved by a more liberal distribution of
ORS sachets.