Sociocultural and Structural Factors Contributing to Delays in Treatment for Children with Severe Malaria: A Qualitative Study in Southwestern Uganda
Authors
Sundararajan, RadhikaMwanga-Amumpaire, Juliet
Adrama, Harriet
Tumuhairwe, Jackline
Mbabazi, Sheilla
Mworozi, Kenneth
Carroll, Ryan
Bangsberg, David
Boum, Yap
Ware, Norma C
Issue Date
2015-03-23
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Show full item recordAbstract
Malaria is a leading cause of pediatric mortality, and Uganda has the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural factors were 1) interviewee's distinctions of "traditional" versus "hospital" illnesses, which were mutually exclusive and 2) generational conflict, where deference to one's elders, who recommended traditional medicine, was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness, debt, and poverty consistent with a model of structural violence. Our findings inform a number of potential interventions that could alleviate the burden of this preventable, but often fatal, illness. Such interventions could be beneficial in similarly endemic, low-resource settings.PubMed ID
25802438Additional Links
http://www.ajtmh.orgLanguage
enISSN
1476-1645ae974a485f413a2113503eed53cd6c53
10.4269/ajtmh.14-0784
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