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.

Barriers to breastfeeding are shaped by sociocultural context: an exploratory qualitative study in Bangladesh

“…However, in line with our study findings, previous studies have revealed a few misperceptions about administering honey, sugar, or water and mustard oil which disrupted breastfeeding practices [ 27 , 29 ]. We heard informally from a few mothers that they tried to reduce some misperceptions of other family members, but that they often failed as gendered issues persist in children’s households, as detailed elsewhere [ 37 ]. As a result, breastfeeding practices are still suboptimal [ 29 , 38 , 39 ].…”

“…and their family members. As part of a larger evaluation of a home fortification with micronutrient power (MNP) programme in Bangladesh [ 35 – 37 ], we conducted this study aimed at understanding the barriers to breastfeeding among a wide range of mothers of infants and young children.…”

An Observational Study of Paediatric Preoperative Transfusion Practice in a Resource‐Limited Setting

“…This study had a significantly high percentage of males (73%). Studies in Bangladesh and south Asia have shown that the sex of a child can influence parental health seeking behaviour and adherence to treatment [ 14 – 16 ]. However, these factors were not investigated in this study and hence we cannot determine the reasons for this difference.…”

Treatment-seeking and recovery among young undernourished children post-hospital discharge in Bangladesh: A qualitative study

“…We discuss three cross-cutting issues in more detail in this paper: early discharge from hospital against medical advice; post-discharge treatment-seeking behavior and recovery; and concerns about inappropriate use of antibiotics. In a separate paper [43], we explore the gender issues and influences in more depth, highlighting a complex web of gender related influences at health systems/services and household/community levels with important implications for young children's recovery post-discharge. At household/community levels, include gender roles in homes (with women typically primary caretakers for children, and male family members having a dominant decision-making role in relation to food and treatment-seeking), and an indication of greater reluctance among parents to invest money and time in the treatment of female children, as compared to male children.…”

“…At household/community levels, include gender roles in homes (with women typically primary caretakers for children, and male family members having a dominant decision-making role in relation to food and treatment-seeking), and an indication of greater reluctance among parents to invest money and time in the treatment of female children, as compared to male children. Further contextually relevant gender analyses are needed to improve health-related interventions, programs and policies [43,44]. In another paper (submitted) [45], we explore the potential role of community health workers…”