Healthcare Seeking and Access to Care for Pneumonia, Sepsis, Meningitis, and Malaria in Rural Gambia

Abstract

Children with acute infectious diseases may not present to health facilities, particularly in low-income countries. We investigated healthcare seeking using a cross-sectional community survey, health facility-based exit interviews, and interviews with customers of private pharmacies in 2014 in Upper River Region (URR) The Gambia, within the Basse Health & Demographic Surveillance System. We estimated access to care using surveillance data from 2008 to 2017 calculating disease incidence versus distance to the nearest health facility. In the facility-based survey, children and adult patients sought care initially at a pharmacy (27.9% and 16.7% respectively), from a relative (23.1% and 28.6%), at a local shop or market (13.5% and 16.7%), and on less than 5% of occasions with a community-based health worker, private clinic, or traditional healer. In the community survey, recent symptoms of pneumonia or sepsis (15% and 1.5%) or malaria (10% and 4.6%) were common in children and adults. Rates of reported healthcare-seeking were high with families of children favoring health facilities and adults favoring pharmacies. In the pharmacy survey, 47.2% of children and 30.4% of adults had sought care from health facilities before visiting the pharmacy. Incidence of childhood disease declined with increasing distance of the household from the nearest health facility with access to care ratios of 0.75 for outpatient pneumonia, 0.82 for hospitalized pneumonia, 0.87 for bacterial sepsis, and 0.92 for bacterial meningitis. In rural Gambia, patients frequently seek initial care at pharmacies and informal drug-sellers rather than community-based health workers. Surveillance underestimates disease incidence by 8–25%.

Caregivers’ perception of risk for malaria, helminth infection and malaria-helminth co-infection among children living in urban and rural settings of Senegal: a qualitative study

“…Empirical studies of malaria 13,14 have shown that delay in seeking early and appropriate care was largely due to poor perception of the risk of a child’s vulnerability to the diseases by the caregivers. In other studies 15,16 , most caregivers who demonstrated acceptable health-seeking behaviour recognised the danger signs for severe forms of malaria, pneumonia, diarrhoea and meningitis. However, few studies 15,17 have investigated the caregivers’ perception to the risk of dual or multiple infections such as malaria and worms.…”

“…In other studies 15,16 , most caregivers who demonstrated acceptable health-seeking behaviour recognised the danger signs for severe forms of malaria, pneumonia, diarrhoea and meningitis. However, few studies 15,17 have investigated the caregivers’ perception to the risk of dual or multiple infections such as malaria and worms. Understanding the importance of malaria-helminth coinfection and its influence on health-seeking behaviour from the caregivers’ perspectives is critical to the development and uptake of integrated approaches to prevention and treatment to the co-infection.…”

Caregivers’ perception of risk for malaria, helminth infection and malaria-helminth co-infection among children living in urban and rural settings of Senegal: A qualitative study

“…Empirical studies on malaria [13,14] have shown that delay in seeking early and appropriate care was largely due to poor perception about the risk of a child's vulnerability to the diseases by the caregivers. In other studies [15,16], most caregivers who demonstrated acceptable health-seeking behaviour recognised the danger signs for severe forms of malaria, pneumonia, diarrhoea and meningitis. However, very few studies [15,17] have investigated the caregivers' perception to the risk of dual or multiple infections such as malaria and helminths.…”

“…In other studies [15,16], most caregivers who demonstrated acceptable health-seeking behaviour recognised the danger signs for severe forms of malaria, pneumonia, diarrhoea and meningitis. However, very few studies [15,17] have investigated the caregivers' perception to the risk of dual or multiple infections such as malaria and helminths. Understanding the importance of malaria-helminth co-infection and its influence on health-seeking behaviour from the caregivers' perspectives is critical to the development and uptake of integrated approaches to prevention and treatment to the co-infection.…”

“…Given that caregivers' perceptions were previously shown to be related to gender, age, prior experience and place of domicile [15,17], we purposely selected respondents with different backgrounds. This sampling strategy led to the diversity of gender, age, prior experience and place of domicile, whether in a rural or an urban setting.…”