Abstract
.Febrile illnesses, such as malaria and pneumonia, are among the most common causes of mortality in children younger than 5 years in Uganda outside of the neonatal period. Their impact could be mitigated through earlier diagnosis and treatment at biomedical facilities; however, it is estimated that a large percentage of Ugandans (70–80%) seek traditional healers for their first line of medical care. This study sought to characterize individual and structural influences on health care–seeking behaviors for febrile children. Minimally structured, qualitative interviews were conducted for 34 caregivers of children presenting to biomedical and traditional healer sites, respectively. We identified six themes that shape the pathway of care for febrile children: 1) peer recommendations, 2) trust in biomedicine, 3) trust in traditional medicine, 4) mistrust in providers and therapies, 5) economic resources and access to health care, and 6) perceptions of child health. Biomedical providers are preferred by those who value laboratory testing and formal medical training, whereas traditional healer preference is heavily influenced by convenience, peer recommendations, and firm beliefs in traditional causes of illness. However, most caregivers concurrently use both biomedical and traditional therapies for their child during the same illness cycle. The biomedical system is often considered as a backup when traditional healing “fails.” Initiatives seeking to encourage earlier presentation to biomedical facilities must consider the individual and structural forces that motivate seeking traditional healers. Educational programs and cooperation with traditional healers may increase biomedical referrals and decrease time to appropriate care and treatment for vulnerable/susceptible children.
Highlights
Febrile illnesses remain the most common cause of mortality in children younger than 5 years in Uganda outside of the neonatal period.[1,2,3] These include potentially treatable infections such as pneumonia, malaria, and diarrheal disease.[3]
Local government-funded clinics have limited testing capabilities and supplies, whereas private clinics vary in quality and are largely cost-prohibitive to all but Ugandans of the highest socioeconomic status.[12]
Through careful, repeated examination and iterative review of the dataset, interpretation, and grouping of codes, we identified six themes that are central to the health care–seeking pathway for febrile children in our study population.[38]
Summary
Febrile illnesses remain the most common cause of mortality in children younger than 5 years in Uganda outside of the neonatal period.[1,2,3] These include potentially treatable infections such as pneumonia, malaria, and diarrheal disease.[3]. To reduce pediatric morbidity and mortality from curable diseases, there must be a better understanding of how caregivers manage illness among high-risk children outside of biomedical facilities. Care-seeking behavior of caregivers of febrile children in Uganda and other areas of sub-Saharan Africa is variable and not well understood.[8,9,10,11] Despite government-funded biomedical health facilities being free, larger referral hospitals where resources are concentrated tend to be less accessible for those living in rural areas. Local government-funded clinics have limited testing capabilities and supplies, whereas private clinics vary in quality and are largely cost-prohibitive to all but Ugandans of the highest socioeconomic status.[12] Uganda is a medically pluralistic context, and caregivers of sick children may use informal healthcare resources, such as traditional healers[13,14,15,16] and unlicensed drug shops.[6,17,18,19,20] These informal resources are sought concurrently with, or instead of, biomedical resources
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