Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community
Abstract Background Where access to facilities for childhood diarrhea and pneumonia is inadequate, community case management (CCM) is an effective way of improving access to care. In Pakistan, utilization of CCM for these diseases through the Lady Health Worker Program remains low. Challenges of acc...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-01-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-018-2845-z |
| _version_ | 1818321669834407936 |
|---|---|
| author | Wafa Aftab Leah Shipton Fauziah Rabbani Kashif Sangrasi Shagufta Perveen Aysha Zahidie Imran Naeem Shamim Qazi |
| author_facet | Wafa Aftab Leah Shipton Fauziah Rabbani Kashif Sangrasi Shagufta Perveen Aysha Zahidie Imran Naeem Shamim Qazi |
| author_sort | Wafa Aftab |
| collection | DOAJ |
| description | Abstract Background Where access to facilities for childhood diarrhea and pneumonia is inadequate, community case management (CCM) is an effective way of improving access to care. In Pakistan, utilization of CCM for these diseases through the Lady Health Worker Program remains low. Challenges of access to facilities persist leading to delayed care and poor outcomes. Estimating caregiver knowledge, understanding their perceptions and practices, and recognizing how these are related to care seeking decisions about childhood diarrhea and pneumonia is crucial to bring about coherence between supply and demand-side practices. Methods Data was collected from family caregivers to explore their knowledge, perceptions and practices regarding childhood diarrhea and pneumonia. Data from a household survey with 7025 caregivers, seven focus group discussion (FGDs), seven in-depth interviews (IDIs), and 20 detailed narrative interviews are used to explore caregiver knowledge, perceptions and practices. Results Household survey shows that most family caregivers recognize main signs and symptoms of diarrhea such as loose stools (76%). Fewer recognize signs and symptoms of pneumonia such as breathing problems (21%). Few caregivers (18%) have confidence in lady health workers’ (LHWs) ability to treat childhood diarrhea and pneumonia. Care seeking from LHWs remains negligible (< 1%). Caregivers overwhelmingly prefer to seek care from doctors (97%). Seventy-five percent caregivers sought care from private providers and 45% from public providers. FGDs, IDIs, and narrative interviews show that care mostly begins with home remedies and sometimes self-prescribed medicines. Treatment delays occur because of caregiver inability to recognize disease, use of home remedies, financial constraints, and low utilization of community based LHW services. Caregivers do not seek care from LHWs because of lack of trust and LHWs’ inability to provide medicines. If finances allow, private doctors, who caregivers perceive as more responsive, are preferred over public sector doctors. Financial resources, availability of time, support for household chores by family and community determine whether, when, and from whom caregivers seek care. Conclusions Many children do not receive recommended diarrhea and pneumonia treatment on time. Taking into consideration caregiver concerns, adequate supply of medicines to LHWs, improved facility level care could improve care seeking practices and child health outcomes. Trial registration The trial is registered with ‘Australian New Zealand Clinical Trials Registry’. Registration Number: ACTRN12613001261707. Registered 18 November 2013. |
| first_indexed | 2024-12-13T10:44:35Z |
| format | Article |
| id | doaj.art-a056bc3cce5b45f2bef5bd7e0be43db4 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-13T10:44:35Z |
| publishDate | 2018-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-a056bc3cce5b45f2bef5bd7e0be43db42022-12-21T23:50:18ZengBMCBMC Health Services Research1472-69632018-01-0118111010.1186/s12913-018-2845-zExploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani communityWafa Aftab0Leah Shipton1Fauziah Rabbani2Kashif Sangrasi3Shagufta Perveen4Aysha Zahidie5Imran Naeem6Shamim Qazi7Department of Community Health Sciences, The Aga Khan UniversityDalla Lana School of Public Health, University of TorontoDepartment of Community Health Sciences, The Aga Khan UniversityDepartment of Community Health Sciences, The Aga Khan UniversityDepartment of Community Health Sciences, The Aga Khan UniversityDepartment of Community Health Sciences, The Aga Khan UniversityDepartment of Community Health Sciences, The Aga Khan UniversityDepartment of Maternal, Newborn, Child and Adolescent Health, World Health OrganizationAbstract Background Where access to facilities for childhood diarrhea and pneumonia is inadequate, community case management (CCM) is an effective way of improving access to care. In Pakistan, utilization of CCM for these diseases through the Lady Health Worker Program remains low. Challenges of access to facilities persist leading to delayed care and poor outcomes. Estimating caregiver knowledge, understanding their perceptions and practices, and recognizing how these are related to care seeking decisions about childhood diarrhea and pneumonia is crucial to bring about coherence between supply and demand-side practices. Methods Data was collected from family caregivers to explore their knowledge, perceptions and practices regarding childhood diarrhea and pneumonia. Data from a household survey with 7025 caregivers, seven focus group discussion (FGDs), seven in-depth interviews (IDIs), and 20 detailed narrative interviews are used to explore caregiver knowledge, perceptions and practices. Results Household survey shows that most family caregivers recognize main signs and symptoms of diarrhea such as loose stools (76%). Fewer recognize signs and symptoms of pneumonia such as breathing problems (21%). Few caregivers (18%) have confidence in lady health workers’ (LHWs) ability to treat childhood diarrhea and pneumonia. Care seeking from LHWs remains negligible (< 1%). Caregivers overwhelmingly prefer to seek care from doctors (97%). Seventy-five percent caregivers sought care from private providers and 45% from public providers. FGDs, IDIs, and narrative interviews show that care mostly begins with home remedies and sometimes self-prescribed medicines. Treatment delays occur because of caregiver inability to recognize disease, use of home remedies, financial constraints, and low utilization of community based LHW services. Caregivers do not seek care from LHWs because of lack of trust and LHWs’ inability to provide medicines. If finances allow, private doctors, who caregivers perceive as more responsive, are preferred over public sector doctors. Financial resources, availability of time, support for household chores by family and community determine whether, when, and from whom caregivers seek care. Conclusions Many children do not receive recommended diarrhea and pneumonia treatment on time. Taking into consideration caregiver concerns, adequate supply of medicines to LHWs, improved facility level care could improve care seeking practices and child health outcomes. Trial registration The trial is registered with ‘Australian New Zealand Clinical Trials Registry’. Registration Number: ACTRN12613001261707. Registered 18 November 2013.http://link.springer.com/article/10.1186/s12913-018-2845-zDeveloping countryCommunity health workerDiarrheaPneumoniaCommunity case managementChild health services |
| spellingShingle | Wafa Aftab Leah Shipton Fauziah Rabbani Kashif Sangrasi Shagufta Perveen Aysha Zahidie Imran Naeem Shamim Qazi Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community BMC Health Services Research Developing country Community health worker Diarrhea Pneumonia Community case management Child health services |
| title | Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community |
| title_full | Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community |
| title_fullStr | Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community |
| title_full_unstemmed | Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community |
| title_short | Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community |
| title_sort | exploring health care seeking knowledge perceptions and practices for childhood diarrhea and pneumonia and their context in a rural pakistani community |
| topic | Developing country Community health worker Diarrhea Pneumonia Community case management Child health services |
| url | http://link.springer.com/article/10.1186/s12913-018-2845-z |
| work_keys_str_mv | AT wafaaftab exploringhealthcareseekingknowledgeperceptionsandpracticesforchildhooddiarrheaandpneumoniaandtheircontextinaruralpakistanicommunity AT leahshipton exploringhealthcareseekingknowledgeperceptionsandpracticesforchildhooddiarrheaandpneumoniaandtheircontextinaruralpakistanicommunity AT fauziahrabbani exploringhealthcareseekingknowledgeperceptionsandpracticesforchildhooddiarrheaandpneumoniaandtheircontextinaruralpakistanicommunity AT kashifsangrasi exploringhealthcareseekingknowledgeperceptionsandpracticesforchildhooddiarrheaandpneumoniaandtheircontextinaruralpakistanicommunity AT shaguftaperveen exploringhealthcareseekingknowledgeperceptionsandpracticesforchildhooddiarrheaandpneumoniaandtheircontextinaruralpakistanicommunity AT ayshazahidie exploringhealthcareseekingknowledgeperceptionsandpracticesforchildhooddiarrheaandpneumoniaandtheircontextinaruralpakistanicommunity AT imrannaeem exploringhealthcareseekingknowledgeperceptionsandpracticesforchildhooddiarrheaandpneumoniaandtheircontextinaruralpakistanicommunity AT shamimqazi exploringhealthcareseekingknowledgeperceptionsandpracticesforchildhooddiarrheaandpneumoniaandtheircontextinaruralpakistanicommunity |