“Children get sick all the time”: A qualitative study of socio-cultural and health system factors contributing to recurrent child illnesses in rural Burkina Faso

Abstract

BackgroundIn Burkina Faso, the government has implemented various health sector reforms in order to overcome financial and geographical barriers to citizens’ access to primary healthcare throughout the country. Despite these efforts, morbidity and mortality rates among children remain high and the utilization of public healthcare services low. This study explores the relationship between mothers’ intentions to use public health services in cases of child sickness, their social strategies and cultural practices to act on these intentions and the actual services provided at the primary health care facilities. Focusing on mothers as the primary caregivers, we follow their pathways from the onset of symptoms through their various attempts of providing treatment for their sick children. The overall objective is to discuss the interconnectedness of various factors, inside and outside of the primary health care services that contribute to the continuing high child morbidity and mortality rates.MethodsThe study is based on ethnographic fieldwork, including in-depth interviews and follow-up interviews with 27 mothers, informal observations of daily-life activities and structured observations of clinical encounters. Data analysis took the form of thematic analysis.Results and discussionFocusing on the mothers’ social strategies and cultural practices, three forms of responses/actions have been identified: home-treatment, consultation with a traditional specialist, and consultation at the primary health care services. Due to their accumulated vulnerabilities, mothers shift pragmatically from one treatment to another. However, the sporadic nature of their treatment-seeking hinders them in obtaining long-term solutions and the result is recurrent child illnesses and relapses over long periods of time. The routinization of the clinical encounter at rural dispensaries furthermore fails to address these complexities of children’s illnesses.ConclusionsThe analysis of case studies, interviews and observations shows how mothers in a rural area struggle and often fail to receive care at public healthcare facilities. Health service delivery could be organized in a manner that responds better to the needs of these mothers in terms of both access and retention.

Health workers’ perceptions and challenges in implementing meningococcal serogroup a conjugate vaccine in the routine childhood immunization schedule in Burkina Faso

“…Interactions between caregivers and health workers during immunization sessions were considered to be very important factors for complete vaccination, according to health workers in our assessment. This sample of health workers also believed that caregivers' low education levels and illiteracy were having a negative effect on timely adherence to completing the vaccination schedule, confirming findings from previous studies [36,37]. Even though respondents acknowledged that most caregivers know the disease prevention benefits of immunization, uneducated caregivers must be reminded about their appointments because of their inability to read their child health record cards.…”

Knowledge, beliefs and practices regarding prevention of bacterial meningitis in Burkina Faso, 5 years after MenAfriVac mass campaigns

“…Participants rarely reported vaccine refusal by themselves or people they know; when they did, participants reported reasons associated with vaccine hesitancy as defined by WHO [32]: concerns about vaccine safety (confidence), doubts about vaccine effectiveness (complacency), and lack of money (convenience). Our findings echo previous anthropological studies among Burkina Faso populations, which have pinpointed the coexistence of biomedical and local practices and have found limited levels of understanding of what vaccines 'do', how they work and how they are produced, in parallel to high acceptance of vaccination in general [21,33,34]. Such insights confirm earlier anthropological findings that people do not need to know a vaccine's contents, actions, or targeted diseases in order to accept it [35].…”

Factors related to quilombola attendance to child follow-up appointments

“…In the case of quilombola children, it must be considered that this scenario may be related to the distance of this population's culture, who, by interacting with different social symbolic contexts, apprehends new ways of taking care of their children and dealing with sickness, devaluing the traditional alternatives of African-descendent culture, such as the use of teas and herbs, ointments, massages, baths, spiritual support, among others. Even tough these practices are not highlighted in this study, using the resources of the African-descendent culture itself is still valued by African mothers belonging to rural communities (24) .…”