Gender-related influences on adherence to advice and treatment-seeking guidance for infants and young children post-hospital discharge in Bangladesh

Abstract

Background: Post-hospital discharge mortality risk is high among young children in many low and middle-income countries (LMICs). The available literature suggests that child, caregiver and health care provider gender all play important roles in post-discharge adherence to medical advice, treatment-seeking and recovery for ill children in LMICs, including those with undernutrition. Methods: A qualitative study was embedded within a larger multi-country multi-disciplinary observational cohort study involving children aged less than 2 years conducted by the Childhood Acute Illness and Nutrition (CHAIN) Network. Primary data were collected from family members of 22 purposively selected cohort children. Family members were interviewed several times in their homes over the 6 months following hospital discharge (total n=78 visits to homes). These in-depth interviews were complemented by semi-structured individual interviews with 6 community representatives, 11 community health workers and 12 facility-based health workers, and three group discussions with a total of 24 community representatives. Data were analysed using NVivo11 software, using both narrative and thematic approaches. Results: We identified gender-related influences at health service/system and household/community levels. These influences interplayed to family members’ adherence to medical advice and treatment-seeking after hospital discharge, with potentially important implications for children’s recovery. Health service/system level influences included: fewer female medical practitioners in healthcare facilities, which influenced mothers’ interest and ability to consult them promptly for their child’s illnesses; gender-related challenges for community health workers in supporting mothers with counselling and advice; and male caregivers’ being largely absent from the paediatric wards where information sessions to support post-discharge care are offered. Gendered household/community level influences included: women’s role as primary caretakers for children and available levels of support; male family members having a dominant role in decision-making related to food and treatment-seeking behaviour; and greater reluctance among parents to invest money and time in the treatment of female children, as compared to male children. Conclusions: A complex web of gender related influences at health systems/services and household/community levels have important implications for young children’s recovery post-discharge. Immediate interventions with potential for positive impact include awareness-raising among all stakeholders – including male family members - on how gender influences child health and recovery, and how to reduce adverse consequences of gender-based discrimination. Specific interventions could include communication interventions in facilities and homes, and changes in routine practices such as who is present in facility interactions. To maximise and sustain the impact of immediate actions and interventions, the structural drivers of women’s position in society and gender inequity must also be tackled. This requires interventions to ensure equal equitable opportunities for men and women in all aspects of life, including access to education and income generation activities. Given patriarchal norms locally and globally, men will likely need special targeting and support in achieving these objectives.

Understanding malnutrition management through a socioecological lens: Evaluation of a community‐based child malnutrition program in rural Uganda

“…Whilst many studies on nutrition highlight that maternal education, poverty and gender inequality can influence children's nutritional status (Kajjura et al, 2019; Kumeh et al, 2020; Nankinga et al, 2019; Uddin et al, 2021), few evaluations of CMAM programs consider these factors. These studies recommend assessing the educational, economic and food needs of entire households, as well as family dynamics, domestic violence and women's empowerment (Shah More et al, 2018; Sharma & Subramanyam, 2021; Tette et al, 2016).…”

Understanding malnutrition management through a socioecological lens: Evaluation of a community-based child malnutrition program in rural Uganda

“…43 It has been argued elsewhere that an intersectional framework should be used when assessing health interventions to grasp how individual dynamics intersect with structural factors to shape patterns of health vulnerabilities and inequities. [44][45][46][47][48] In our evaluation, we found that caregivers' social identities, including their gender, literacy level, living conditions, and socioeconomic status, interacted with broader systems of oppression such as poverty, gendered norms and household inequalities, women's limited access to education and employment, and lack of social protections.…”

“…Yet, many evaluations of CMAM programs adopt biomedical or behavioural health approaches, neglecting to explore factors beyond the individual that can influence malnutrition management (Abubakar, 2013). It has been argued that the multilevel determinants of children’s health should be studied concurrently when assessing health interventions, to grasp how individual factors interact with structural factors to shape patterns of health vulnerability and inequity (Nisbett & Harris, 2018; Uddin et al, 2021). CMAM programs should therefore consider these barriers and examine how structural determinants can hinder caregivers’ capacity to uphold CMAM protocols (Kim et al, 2013).…”

“…While many studies on nutrition highlight that maternal education, poverty and gender inequality can influence children’s nutritional status (Kajjura et al, 2019; Kumeh et al, 2020; Nankinga et al, 2019; Uddin et al, 2021), few evaluations of CMAM programs consider these factors in their analysis. These studies recommend assessing economic and food needs of entire households, family dynamics, domestic violence, and women’s empowerment (Shah More et al, 2018; Sharma & Subramanyam, 2021; Tette et al, 2016).…”

An Observational Study of Paediatric Preoperative Transfusion Practice in a Tertiary Care Lab in Delhi NCR Region, India

“…73% of the participants in this study were men, a notably high proportion. The sex of a child can affect parental healthseeking behaviour and treatment compliance, according to studies conducted in Delhi and Haryana [20,21,22]. We are unable to ascertain the causes of this discrepancy because these parameters were not examined in this investigation.…”