Sociocultural and Structural Factors Contributing to Delays in Treatment for Children with Severe Malaria: A Qualitative Study in Southwestern Uganda
Identifieur interne : 001384 ( Main/Exploration ); précédent : 001383; suivant : 001385Sociocultural and Structural Factors Contributing to Delays in Treatment for Children with Severe Malaria: A Qualitative Study in Southwestern Uganda
Auteurs : Radhika Sundararajan ; Juliet Mwanga-Amumpaire ; Harriet Adrama ; Jackline Tumuhairwe ; Sheilla Mbabazi ; Kenneth Mworozi ; Ryan Carroll ; David Bangsberg ; Yap Boum Ii ; Norma C. WareSource :
- The American Journal of Tropical Medicine and Hygiene [ 0002-9637 ] ; 2015.
Abstract
Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural factors were 1) interviewee's distinctions of “traditional” versus “hospital” illnesses, which were mutually exclusive and 2) generational conflict, where deference to one's elders, who recommended traditional medicine, was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness, debt, and poverty consistent with a model of
Url:
DOI: 10.4269/ajtmh.14-0784
PubMed: 25802438
PubMed Central: 4426580
Affiliations:
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<author><name sortKey="Mworozi, Kenneth" sort="Mworozi, Kenneth" uniqKey="Mworozi K" first="Kenneth" last="Mworozi">Kenneth Mworozi</name>
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<author><name sortKey="Carroll, Ryan" sort="Carroll, Ryan" uniqKey="Carroll R" first="Ryan" last="Carroll">Ryan Carroll</name>
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<series><title level="j">The American Journal of Tropical Medicine and Hygiene</title>
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<front><div type="abstract" xml:lang="en"><p>Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural factors were 1) interviewee's distinctions of “traditional” versus “hospital” illnesses, which were mutually exclusive and 2) generational conflict, where deference to one's elders, who recommended traditional medicine, was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness, debt, and poverty consistent with a model of <italic>structural violence</italic>
. Our findings inform a number of potential interventions that could alleviate the burden of this preventable, but often fatal, illness. Such interventions could be beneficial in similarly endemic, low-resource settings.</p>
</div>
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<name sortKey="Mbabazi, Sheilla" sort="Mbabazi, Sheilla" uniqKey="Mbabazi S" first="Sheilla" last="Mbabazi">Sheilla Mbabazi</name>
<name sortKey="Mwanga Amumpaire, Juliet" sort="Mwanga Amumpaire, Juliet" uniqKey="Mwanga Amumpaire J" first="Juliet" last="Mwanga-Amumpaire">Juliet Mwanga-Amumpaire</name>
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