In 2008, approximately 8.8 million children under 5 years of age died worldwide. . Most of these deaths occurred in developing countries [2, 3]. An estimated 2.7 billion people are still living on less than 2 US dollars a day . The major causes of child mortality are pneumonia, diarrhea, malaria, and other infectious diseases [3, 5]. Deaths from these diseases might be preventable if early and appropriate treatment were rendered . Mothers in developing countries, however, often do not have sufficient knowledge of signs that their child's health is in danger, or of appropriate treatments, or access to appropriate health services . Poor mothers are also more likely to live in remote areas, which can lead to delays in seeking care, and to fatalities. A mother's care-seeking behavior is therefore particularly important in resource-poor countries.
Kroeger  provided a holistic framework for examining care-seeking behaviors, which is applicable for developing countries. His framework covers major dimensions of health-seeking behaviors, namely, sociodemographics, physical accessibility, medical cost for treatment, women's autonomy, and given health service factors.
Existing studies have shown that factors associated with a mother's care-seeking behaviors when faced with childhood illness are as follows: the mother's level of education [8–10], economic status [8, 11, 12], mother's age  ethnicity [13–17], distance to the health care facility [9, 18, 19], the child's age , birth order of the child [21, 22], child nutritional status [12, 23], lack of recognition of the severity of the illness [13, 22, 24], the presence of diarrhea  or respiratory disease [14, 24], prior participation in health education [8, 26], knowing a medical doctor , and the quality of the health care services provided [28, 29].
Nicaragua is one of the poorest countries in Latin America and the Caribbean, followed by Haiti . Its per capita gross national income (GNI) was 980 US dollars (USD) (2007) , which is one-third the regional average . Moreover, Nicaragua has huge economic inequalities . The Gini coefficient in Nicaragua was reported to be 0.54 in 2006 (0 = perfect equality, 1 = perfect inequality), with the wealthiest 20% earning approximately 60% of the country's total income . Approximately 50-60% live below the extreme poverty line (living on less than 1.25 US dollars per day) .
Nevertheless, between 1980 and 2007, Nicaragua has succeeded in reducing its infant mortality rate (IMR) by almost two-thirds, from 82/1,000 to 28/1,000 and the under-5 years of age child mortality rate (U5MR) from 113/1,000 to 35/1000. However, huge domestic disparities remained. The IMR in the richest quintile was 16/1,000, while that of the poorest quintile was 50/1,000 . Similarly, the U5MR was 19/1,000 in the richest quintile and 64/1,000 in the poorest quintile . The majority of poor mothers live in remote rural areas where medical services are scarce, and little is known about how they behave in seeking medical care when their children get sick.
We examined poor mothers' care-seeking behaviors in response to childhood illness, and identified factors affecting their choices. We also assessed mothers' perceptions of the medical services and their confidence in the health care offered to their children.