Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community

Wafa Aftab,Aysha Zahidie,Shamim Qazi,Imran Naeem,Kashif Sangrasi,Shagufta Perveen,Fauziah Rabbani,Leah Shipton

doi:10.1186/s12913-018-2845-z

Abstract

BackgroundWhere access to facilities for childhood diarrhea and pneumonia is inadequate, community case management (CCM) is an effective way of improving access to care. In Pakistan, utilization of CCM for these diseases through the Lady Health Worker Program remains low. Challenges of access to facilities persist leading to delayed care and poor outcomes. Estimating caregiver knowledge, understanding their perceptions and practices, and recognizing how these are related to care seeking decisions about childhood diarrhea and pneumonia is crucial to bring about coherence between supply and demand-side practices.MethodsData was collected from family caregivers to explore their knowledge, perceptions and practices regarding childhood diarrhea and pneumonia. Data from a household survey with 7025 caregivers, seven focus group discussion (FGDs), seven in-depth interviews (IDIs), and 20 detailed narrative interviews are used to explore caregiver knowledge, perceptions and practices.ResultsHousehold survey shows that most family caregivers recognize main signs and symptoms of diarrhea such as loose stools (76%). Fewer recognize signs and symptoms of pneumonia such as breathing problems (21%). Few caregivers (18%) have confidence in lady health workers’ (LHWs) ability to treat childhood diarrhea and pneumonia. Care seeking from LHWs remains negligible (< 1%). Caregivers overwhelmingly prefer to seek care from doctors (97%). Seventy-five percent caregivers sought care from private providers and 45% from public providers.FGDs, IDIs, and narrative interviews show that care mostly begins with home remedies and sometimes self-prescribed medicines. Treatment delays occur because of caregiver inability to recognize disease, use of home remedies, financial constraints, and low utilization of community based LHW services. Caregivers do not seek care from LHWs because of lack of trust and LHWs’ inability to provide medicines. If finances allow, private doctors, who caregivers perceive as more responsive, are preferred over public sector doctors. Financial resources, availability of time, support for household chores by family and community determine whether, when, and from whom caregivers seek care.ConclusionsMany children do not receive recommended diarrhea and pneumonia treatment on time. Taking into consideration caregiver concerns, adequate supply of medicines to LHWs, improved facility level care could improve care seeking practices and child health outcomes.Trial registrationThe trial is registered with ‘Australian New Zealand Clinical Trials Registry’. Registration Number: ACTRN12613001261707. Registered 18 November 2013.

Highlights

Where access to facilities for childhood diarrhea and pneumonia is inadequate, community case management (CCM) is an effective way of improving access to care
Forty-five caregivers participated in Focus Group Discussion (FGD) and In-depth Interview (IDI)
Our results show that most family caregivers utilize knowledge accumulated through family and personal experiences as the main source of information about pneumonia and diarrhea care

Summary

Introduction

Where access to facilities for childhood diarrhea and pneumonia is inadequate, community case management (CCM) is an effective way of improving access to care. Challenges of access to facilities persist leading to delayed care and poor outcomes. Existing effective interventions delivered at high coverage can prevent majority of deaths due to diarrhea and pneumonia among children under five years of age [1]. Where access to facilitybased care is low, community case management (CCM) of diarrhea and pneumonia is one of the most effective interventions for reducing under-five mortality due to these diseases [1]. Poor family caregiver disease recognition and delayed care seeking from skilled providers leads to preventable morbidity and mortality from diarrhea and pneumonia [4]

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