Delays in seeking and receiving health care services for pneumonia in children under five in the Peruvian Amazon: A mixed-methods study on caregivers' perceptions

Mónica J. Pajuelo, Cynthia Anticona Huaynate, Malena Correa, Holger Mayta Malpartida, Cesar Ramal Asayag, Juan R. Seminario, Robert H Gilman, Laura Murphy, Richard A. Oberhelman, Valerie A. Paz-Soldan

Research output: Contribution to journalReview article

Abstract

Background: Delays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents' limited education and their difficulties in recognizing the severity of the illness. The "three delays" was a model originally proposed to describe the most common determinants of maternal mortality, but has been adapted to describe delays in the health seeking process for caregivers of children under five. This study aims to explore the caregivers' perceived barriers for seeking and receiving health care services in children under five years old admitted to a referral hospital for community-acquired pneumonia in the Peruvian Amazon Region using the three-delays model framework. Methods: There were two parts to this mixed-method, cross-sectional, hospital-based study. First, medical charts of 61 children (1 to 60 months old) admitted for pneumonia were reviewed, and clinical characteristics were noted. Second, to examine health care-seeking decisions and actions, as well as associated delays in the process of obtaining health care services, we interviewed 10 of the children's caregivers. Results: Half of the children in our study were 9 months old or less. Main reasons for seeking care at the hospital were cough (93%) and fever (92%). Difficulty breathing and fast breathing were also reported in more than 60% of cases. In the interviews, caregivers reported delays of 1 to 14 days to go to the closest health facility. Factors perceived as causes for delays in deciding to seek care were apparent lack of skills to recognize signs and symptoms and of confidence in the health system, and practicing self-medication. No delays in reaching a health facility were reported. Once the caregivers reached a health facility, they perceived lack of competence of medical staff and inadequate treatment provided by the primary care physicians. Conclusion: According to caregivers, the main delays to get health care services for pneumonia among young children were identified in the initial decision of caregivers to seek healthcare and in the health system to provide it. Specific interventions targeted to main barriers may be useful for reducing delays in providing appropriate health care for children with pneumonia.

Original languageEnglish (US)
Article number149
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
StatePublished - Mar 1 2018

Fingerprint

Caregivers
Health Services
Pneumonia
Delivery of Health Care
Health Facilities
Health
Respiration
Self Medication
Maternal Mortality
Medical Staff
Primary Care Physicians
Child Care
Cough
Mental Competency
Signs and Symptoms
Fever
Referral and Consultation
Parents
Interviews
Education

Keywords

  • Caregiver
  • Child pneumonia
  • Delays
  • Health system
  • Seek care

ASJC Scopus subject areas

  • Health Policy

Cite this

Pajuelo, M. J., Anticona Huaynate, C., Correa, M., Mayta Malpartida, H., Ramal Asayag, C., Seminario, J. R., ... Paz-Soldan, V. A. (2018). Delays in seeking and receiving health care services for pneumonia in children under five in the Peruvian Amazon: A mixed-methods study on caregivers' perceptions. BMC Health Services Research, 18(1), [149]. https://doi.org/10.1186/s12913-018-2950-z

Delays in seeking and receiving health care services for pneumonia in children under five in the Peruvian Amazon : A mixed-methods study on caregivers' perceptions. / Pajuelo, Mónica J.; Anticona Huaynate, Cynthia; Correa, Malena; Mayta Malpartida, Holger; Ramal Asayag, Cesar; Seminario, Juan R.; Gilman, Robert H; Murphy, Laura; Oberhelman, Richard A.; Paz-Soldan, Valerie A.

In: BMC Health Services Research, Vol. 18, No. 1, 149, 01.03.2018.

Research output: Contribution to journalReview article

Pajuelo, MJ, Anticona Huaynate, C, Correa, M, Mayta Malpartida, H, Ramal Asayag, C, Seminario, JR, Gilman, RH, Murphy, L, Oberhelman, RA & Paz-Soldan, VA 2018, 'Delays in seeking and receiving health care services for pneumonia in children under five in the Peruvian Amazon: A mixed-methods study on caregivers' perceptions', BMC Health Services Research, vol. 18, no. 1, 149. https://doi.org/10.1186/s12913-018-2950-z
Pajuelo, Mónica J. ; Anticona Huaynate, Cynthia ; Correa, Malena ; Mayta Malpartida, Holger ; Ramal Asayag, Cesar ; Seminario, Juan R. ; Gilman, Robert H ; Murphy, Laura ; Oberhelman, Richard A. ; Paz-Soldan, Valerie A. / Delays in seeking and receiving health care services for pneumonia in children under five in the Peruvian Amazon : A mixed-methods study on caregivers' perceptions. In: BMC Health Services Research. 2018 ; Vol. 18, No. 1.
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AU - Correa, Malena

AU - Mayta Malpartida, Holger

AU - Ramal Asayag, Cesar

AU - Seminario, Juan R.

AU - Gilman, Robert H

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AU - Oberhelman, Richard A.

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AB - Background: Delays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents' limited education and their difficulties in recognizing the severity of the illness. The "three delays" was a model originally proposed to describe the most common determinants of maternal mortality, but has been adapted to describe delays in the health seeking process for caregivers of children under five. This study aims to explore the caregivers' perceived barriers for seeking and receiving health care services in children under five years old admitted to a referral hospital for community-acquired pneumonia in the Peruvian Amazon Region using the three-delays model framework. Methods: There were two parts to this mixed-method, cross-sectional, hospital-based study. First, medical charts of 61 children (1 to 60 months old) admitted for pneumonia were reviewed, and clinical characteristics were noted. Second, to examine health care-seeking decisions and actions, as well as associated delays in the process of obtaining health care services, we interviewed 10 of the children's caregivers. Results: Half of the children in our study were 9 months old or less. Main reasons for seeking care at the hospital were cough (93%) and fever (92%). Difficulty breathing and fast breathing were also reported in more than 60% of cases. In the interviews, caregivers reported delays of 1 to 14 days to go to the closest health facility. Factors perceived as causes for delays in deciding to seek care were apparent lack of skills to recognize signs and symptoms and of confidence in the health system, and practicing self-medication. No delays in reaching a health facility were reported. Once the caregivers reached a health facility, they perceived lack of competence of medical staff and inadequate treatment provided by the primary care physicians. Conclusion: According to caregivers, the main delays to get health care services for pneumonia among young children were identified in the initial decision of caregivers to seek healthcare and in the health system to provide it. Specific interventions targeted to main barriers may be useful for reducing delays in providing appropriate health care for children with pneumonia.

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