Care-seeking patterns amongst suspected paediatric pneumonia deaths in rural Malawi

Carina King, Masford Banda, Naor Bar-Zeev, James Beard, Neil French, Charles Makwenda, Eric McCollum, Malizani Mdala, Yasir Bin Nisar, Tambosi Phiri, Shamim Ahmad Qazi, Tim Colbourn

Research output: Contribution to journalArticlepeer-review


Background: Pneumonia remains a leading cause of paediatric deaths. To understand contextual challenges in care pathways, we explored patterns in care-seeking amongst children who died of pneumonia in Malawi. Methods: We conducted a mixed-methods analysis of verbal autopsies (VA) amongst deaths in children aged 1-59 months from 10/2011 to 06/2016 in Mchinji district, Malawi. Suspected pneumonia deaths were defined as: 1. caregiver reported cough and fast breathing in the 2-weeks prior to death; or, 2. the caregiver specifically stated the child died of pneumonia; or 3. cause of death assigned as 'acute respiratory infection' using InterVA-4. Data were extracted from free-text narratives based on domains in the 'Pathways to Survival' framework, and described using proportions. Qualitative analysis used a framework approach, with pre-specified themes. Results: We analysed 171 suspected pneumonia deaths. In total, 86% of children were taken to a healthcare facility during their final illness episode, and 44% sought care more than once. Of children who went to hospital (n=119), 70% were admitted, and 25% received oxygen. Half of the children died within a healthcare setting (43% hospital, 5% health centre and 2% private clinics), 64 (37%) at home, and 22 (13%) in transit. Challenges in delayed care, transport and quality of care (including oxygen), were reported. Conclusions: Healthcare was frequently sought for children who died of suspected pneumonia, however several missed opportunities for care were seen. Sustained investment in timely appropriate care seeking, quick transportation to hospital and improved case management at all levels of the system is needed.

Original languageEnglish (US)
Article number178
JournalGates Open Research
StatePublished - 2020


  • Child
  • Mortality
  • Pathways to survival
  • Pneumonia
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Medicine (miscellaneous)
  • Biochemistry, Genetics and Molecular Biology (miscellaneous)
  • Immunology and Microbiology (miscellaneous)

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