Abstract
BackgroundSurgery can correct congenital heart defects, but disease management in low- and middle-income countries can be challenging and complex due to a lack of referral system, financial resources, human resources, and infrastructure for surgical and post-operative care. This study investigates the experiences of caregivers of children with CHD accessing the health care system and pediatric cardiac surgery.MethodsA qualitative study was conducted at a teaching hospital in Ethiopia. We conducted semi-structured interviews with 13 caregivers of 10 patients with CHD who underwent cardiac surgery. We additionally conducted chart reviews for triangulation and verification. Interviews were conducted in Amharic and then translated into English. Data were analyzed according to the principles of interpretive thematic analysis, informed by the candidacy framework.ResultsThe following four observations emerged from the interviews: (a) most patients were diagnosed with CHD at birth if they were born at a health care facility, but for those born at home, CHD was discovered much later (b) many patients experienced misdiagnoses before seeking care at a large hospital, (c) after diagnosis, patients were waiting for the surgery for more than a year, (d) caregivers felt anxious and optimistic once they were able to schedule the surgical date. During the care-seeking journey, caregivers encountered financial constraints, struggled in a fragmented delivery system, and experienced poor service quality.ConclusionsDelayed access to care was largely due to the lack of early CHD recognition and financial hardships, related to the inefficient and disorganized health care system. Fee waivers were available to assist low-income children in gaining access to health services or medications, but application information was not readily available. Indirect costs like long-distance travel contributed to this challenge. Overall, improvements must be made for district-level screening and the health care workforce.
Highlights
Surgery can correct congenital heart defects, but disease management in low- and middle-income countries can be challenging and complex due to a lack of referral system, financial resources, human resources, and infrastructure for surgical and post-operative care
High fertility rates, and limited access to care add to the burden of Congenital heart disease (CHD) in Low- and middle-income countries (LMIC) [4]
Some patients were diagnosed with Tetralogy of Fallot, atrial septal defects (ASD), and ventricular septal defect (VSD)
Summary
Surgery can correct congenital heart defects, but disease management in low- and middle-income countries can be challenging and complex due to a lack of referral system, financial resources, human resources, and infrastructure for surgical and post-operative care. This study investigates the experiences of caregivers of children with CHD accessing the health care system and pediatric cardiac surgery. As the World Health Organization (WHO) recognized the global burden and threat of non-communicable diseases (NCD) as one of the major challenges of the twenty-first century, increasing access to surgical care is becoming an increasingly important global health agenda due to its potential to save lives, prevent disabilities and decrease the burden of diseases [1, 2]. In addition to an inefficient health care system, the cost of preventing and treating heart diseases in Ethiopia poses a great burden on households [8]. Without the right surgical care, a child’s neglected and exacerbated conditions may lead the caregiver to feel hopeless and distressed [10]
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