Abstract
BackgroundDelays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents’ limited education and their difficulties in recognizing the severity of the illness. The “three delays” was a model originally proposed to describe the most common determinants of maternal mortality, but has been adapted to describe delays in the health seeking process for caregivers of children under five. This study aims to explore the caregivers’ perceived barriers for seeking and receiving health care services in children under five years old admitted to a referral hospital for community-acquired pneumonia in the Peruvian Amazon Region using the three-delays model framework.MethodsThere were two parts to this mixed-method, cross-sectional, hospital-based study. First, medical charts of 61 children (1 to 60 months old) admitted for pneumonia were reviewed, and clinical characteristics were noted. Second, to examine health care-seeking decisions and actions, as well as associated delays in the process of obtaining health care services, we interviewed 10 of the children’s caregivers.ResultsHalf of the children in our study were 9 months old or less. Main reasons for seeking care at the hospital were cough (93%) and fever (92%). Difficulty breathing and fast breathing were also reported in more than 60% of cases. In the interviews, caregivers reported delays of 1 to 14 days to go to the closest health facility. Factors perceived as causes for delays in deciding to seek care were apparent lack of skills to recognize signs and symptoms and of confidence in the health system, and practicing self-medication. No delays in reaching a health facility were reported. Once the caregivers reached a health facility, they perceived lack of competence of medical staff and inadequate treatment provided by the primary care physicians.ConclusionAccording to caregivers, the main delays to get health care services for pneumonia among young children were identified in the initial decision of caregivers to seek healthcare and in the health system to provide it. Specific interventions targeted to main barriers may be useful for reducing delays in providing appropriate health care for children with pneumonia.
Highlights
Delays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents’ limited education and their difficulties in recognizing the severity of the illness
The pathway analysis chart involves systematic questions about the chronological actions that the caregiver took as soon as she/he realized that the child was sick: Who the caregiver asked for help; what this person did or told her/him to do; did the caregiver take the child to a health provider or not; what were the reasons for taking the child; how many days lapsed between actions
One child was suspected of having AIDS; the other child seemed to be suffering from a severe neurological disease
Summary
Delays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents’ limited education and their difficulties in recognizing the severity of the illness. Peruvian public health efforts have focused on pneumonia prevention–through conjugated pneumococcal and Hib vaccines implementation– and on educational and awareness campaigns targeting vulnerable populations (i.e., increasing awareness about emergency signals when facing respiratory illness or distress). Despite these efforts, pneumonia mortality rates remain unchanged (1.2 deaths per 100 pneumonia episodes) among children under 5 years of age, being highest in the Highlands and in the Amazon rainforest [9]. Differences in coding were discussed until agreement was reached
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