Local Barriers and Solutions to Improve Care-Seeking for Childhood Pneumonia, Diarrhoea and Malaria in Kenya, Nigeria and Niger: A Qualitative Study

Bedford, Karen; Sharkey, Alyssa

doi:10.1371/journal.pone.0100038

Cited by 82 publications

(101 citation statements)

References 25 publications

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“…This was supported by KIIs reports that large workloads and few health personnel were among the main causes of delayed services. Similar findings were reported in a study carried out at Homa bay County, Kenya, where long queues or delays at the health facility were found to contribute to delays in seeking care at the hospitals [28]. Other studies done in South Africa, Australia and Central America also reported similar findings, [29,30,31,32].…”

Section: Discussionsupporting

confidence: 86%

Cross Sectional Survey of Care Seeking For Acute Respiratory Illness in Children Under 5 Years in Rural Kenya

Ndungu¹

2018

AJP

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Acute respiratory infection (ARI) is a leading cause of childhood morbidity and mortality in developing countries. In Kenya, diagnosis and treatment of ARI remains predominantly health facility based. This presumes that caretakers can recognize ARI symptoms promptly and make a decision to take the child to an appropriate health facility for treatment. Unfortunately, these presumptions have not been assessed. This study sought to establish determinants of health care seeking among caretakers of children under five years (CU5) of age with ARI. An analytic cross sectional survey was carried out in Githunguri Sub-County of Kiambu County. Households with CU5 who had recently suffered an episode of ARI were enrolled. Structured questionnaires, focused group discussions and key informant guides were used to gather information. Structured questionnaires were administered to caretakers to obtain information on socio-demographics, knowledge and health seeking practices. Bivariate and multivariate analysis was carried out with a p value of < 0.05. From 438 households sampled, 323 (73.7%) had CU5 in their households. Out of these, 240 (74.3%) of the children had an episode of ARI in the preceding 2 weeks. The mean age of the children was 29.2 months, with male to female ratio of 1:1. The mean mothers' age was 29.4 years, 71.2% were married, 54.8% had secondary education and 66.6% were of Christian-protestants faith and (90.0%) were in informal employment. Poor knowledge of pneumonia was documented in 92.5% of caretakers. One hundred and forty nine (62.1%) caretakers had delayed health facility consultation for ARI. The main factors associated with delayed facility consultation were poor knowledge of symptoms (p = 0.007) long distance to the nearest health facility (p = 0.002), means of transport used to access the nearest health facility (p = 0.001) and previous high expenditure at health facility (p = 0.011). On logistic regression, the main factors that independently determined delayed facility consultation were long waiting time (>1hour) before service provision (p = 0.001), use of a motorbike to access the nearest health facility (p = 0.001) and traveling for 4-4.9 kilo meters to the nearest health facility (p = 0.002). Travelling for long distance and long waiting time before service provision during the previous facility visit were the main determinants of delayed facility consultations. The study recommends increased sensitization on symptom recognition among caretakers, and intensified efforts to reduce turnaround time during health facility consultations in order to minimize delays in health facility consultation.

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Section: Discussionsupporting

confidence: 86%

Cross Sectional Survey of Care Seeking For Acute Respiratory Illness in Children Under 5 Years in Rural Kenya

Ndungu¹

2018

AJP

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“…24 Building evidence from highburden countries should be a priority and is essential to a complete understanding of health loss due to LRI. One qualitative study 25 revealed demandside barriers to healthcare utilisation in Nigeria, suggesting that costs, physical distance, cultural considerations, and knowledge of symptoms and warning signs might all play a role in delayed careseeking and could explain behaviours in other locations. In one study 26 of six countries in sub Saharan Africa, only 30% of care givers recognised fast breathing or difficulty in breathing as a symptom of LRI.…”

Section: Discussionmentioning

confidence: 99%

Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017

Troeger¹,

Khalil²,

Blacker³

et al. 2020

The Lancet Infectious Diseases

110

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Background Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. MethodsWe used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years.Findings In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286-873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5-68·5) and in mortality rate (from 362·7 deaths [330·1-392·0] per 100 000 children to 118·9 deaths [109·8-128·3] per 100 000 children; 67·2% decrease, 63·5-70·1). LRI incidence declined globally (32·4% decrease, 27·2-37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0-24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1-6·3), and reductions in household air pollution (8·4%, 6·8-9·2).Interpretation Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribut...

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“…These include prolonged waiting times, poor communication between staff and patients, and negative previous experiences. 27 Despite an adequate number of health facilities, Homabay county suffers from inequities in health worker distribution. Even though there are an average of four doctors and 51 nurses per 100,000 populations, 58% of residents have to travel at least 5 km to the nearest health facility.…”

Section: Methodsmentioning

confidence: 99%

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

Shaw

Asadhi

Owuor

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Integrated community case management (iCCM) programs that train lay community health workers (CHWs) in the diagnosis and treatment of diarrhea, malaria, and pneumonia have been increasingly adopted throughout subSaharan Africa to provide services in areas where accessibility to formal public sector health services is low. One important aspect of successful iCCM programs is the acceptability and utilization of services provided by CHWs. To understand community perceptions of the quality of care in an iCCM intervention in western Kenya, we used the Primary Care Assessment Survey to compare caregiver attitudes about the diagnosis and treatment of childhood pneumonia as provided by CHWs and facility-based health workers (FBHWs). Overall, caregivers rated CHWs more highly than FBHWs across a set of 10 domains that capture multiple dimensions of the care process. Caregivers perceived CHWs to provide higher quality care in terms of accessibility and patient relationship and equal quality care on clinical aspects. These results argue for the continued implementation and scale-up of iCCM programs as an acceptable intervention for increasing access to treatment of childhood pneumonia.

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Local Barriers and Solutions to Improve Care-Seeking for Childhood Pneumonia, Diarrhoea and Malaria in Kenya, Nigeria and Niger: A Qualitative Study

Cited by 82 publications

References 25 publications

Cross Sectional Survey of Care Seeking For Acute Respiratory Illness in Children Under 5 Years in Rural Kenya

Cross Sectional Survey of Care Seeking For Acute Respiratory Illness in Children Under 5 Years in Rural Kenya

Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

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