Abstract
BackgroundCommunity-acquired pneumonia (CAP) is the leading cause of under-five mortality globally with almost one-quarter of deaths occurring in India.ObjectivesTo identify predisposing, enabling and service-related factors influencing treatment delay for CAP in rural communities of two states in India. Factors investigated included recognition of danger signs of CAP, health care decision making, self-medication, treatment and referral by local practitioners, and perceptions about quality of care.MethodsQualitative research employing case studies (CS) of care-seeking, key informant interviews (KII), semi-structured interviews (SSI) and focus group discussions (FGD) with both video presentations of CAP signs, and case scenarios. Interviews and FGDs were conducted with parents of under-five children who had suffered CAP, community health workers (CHW), and rural medical practitioners (RMP).ResultsFrom September 2013 to January 2014, 30 CS, 43 KIIs, 42 SSIs, and 42 FGDs were conducted. Recognition of danger signs of CAP among caregivers was poor. Fast breathing, an early sign of CAP, was not commonly recognized. Chest in-drawing was recognized as a sign of serious illness, but not commonly monitored by removing a child’s clothing. Most cases of mild to moderate CAP were brought to RMP, and more severe cases taken to private clinics in towns. Mothers consulted local RMP directly, but decisions to visit doctors outside the village required consultation with husband or mother-in-law. By the time most cases reached a public tertiary-care hospital, children had been ill for a week and treated by 2-3 providers. Quality of care at government facilities was deemed poor by caregivers.ConclusionTo reduce CAP-associated mortality, recognition of its danger signs and the consequences of treatment delay needed to be better recognized by caregivers, and confidence in government facilities increased. The involvement of RMP in community based CAP programs needs to be investigated further given their widespread popularity.
Highlights
Pneumonia is the single largest cause of mortality in children under-five years of age, responsible for one in five deaths [1]
Most cases of mild to moderate Community-acquired pneumonia (CAP) were brought to rural medical practitioners (RMP), and more severe cases taken to private clinics in towns
Each of the factors we have identified as negatively influencing health care seeking for CAP needs to be addressed in future community based childhood pneumonia programs in India
Summary
Pneumonia is the single largest cause of mortality in children under-five years of age, responsible for one in five deaths [1]. In 2010, there were an estimated 1 3 million deaths due to childhood pneumonia, one-quarter being in India. 81% of the deaths occurred in the first two years of life [2]. Poor and delayed care-seeking has been implicated in 6–70% of child deaths in developing countries, including those from pneumonia [3,4]. Available literature attributes poor careseeking, including delay or no care-seeking, to various social, cultural and logistical barriers at the household, community and health system levels which often interact. Community-acquired pneumonia (CAP) is the leading cause of under-five mortality globally with almost one-quarter of deaths occurring in India
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