Centre for Infectious Disease Epidemiology and Research, Falmouth 5.49, School of Public Health and Family Medicine, University of Cape Town, Observatory 7925, Cape Town, South Africa.
Soc Sci Med. 2013 Jun;86:66-78. doi: 10.1016/j.socscimed.2013.02.031. Epub 2013 Mar 1.
Diarrhoea, pneumonia and malaria are the largest contributors to childhood mortality in sub-Saharan Africa. While supply side efforts to deliver effective and affordable interventions are being scaled up, ensuring timely and appropriate use by caregivers remains a challenge. This systematic review synthesises qualitative evidence on the factors that underpin household recognition and response to child diarrhoea, pneumonia and malaria in sub-Saharan Africa. For this review, we searched six electronic databases, hand searched 12 journals from 1980 to 2010 using key search terms, and solicited expert review. We identified 5104 possible studies and included 112. Study quality was appraised using the Critical Appraisal Skills Program (CASP) tool. We followed a meta-ethnographic approach to synthesise findings according to three main themes: how households understand these illnesses, how social relationships affect recognition and response, and how households act to prevent and treat these illnesses. We synthesise these findings into a conceptual model for understanding household pathways to care and decision making. Factors that influence household careseeking include: cultural beliefs and illness perceptions; perceived illness severity and efficacy of treatment; rural location, gender, household income and cost of treatment. Several studies also emphasise the importance of experimentation, previous experience with health services and habit in shaping household choices. Moving beyond well-known barriers to careseeking and linear models of pathways to care, the review suggests that treatment decision making is a dynamic process characterised by uncertainty and debate, experimentation with multiple and simultaneous treatments, and shifting interpretations of the illness and treatment options, with household decision making hinging on social negotiations with a broad variety of actors and influenced by control over financial resources. The review concludes with research recommendations for tackling remaining gaps in knowledge.
腹泻、肺炎和疟疾是撒哈拉以南非洲儿童死亡的主要原因。虽然正在加大力度提供有效和负担得起的干预措施，但确保照顾者及时和适当地使用这些措施仍然是一个挑战。本系统评价综合了定性证据，这些证据说明了支撑家庭对儿童腹泻、肺炎和疟疾的识别和反应的因素。为此，我们检索了六个电子数据库，使用关键搜索词对手动搜索了 1980 年至 2010 年的 12 种期刊，并征求了专家的审查意见。我们确定了 5104 项可能的研究，并纳入了 112 项研究。使用关键评估技能计划 (CASP) 工具评估研究质量。我们遵循元人种学方法，根据三个主要主题综合研究结果：家庭如何理解这些疾病，社会关系如何影响识别和反应，以及家庭如何采取行动预防和治疗这些疾病。我们将这些发现综合为一个理解家庭护理途径和决策的概念模型。影响家庭护理的因素包括：文化信仰和疾病观念；感知疾病的严重程度和治疗效果；农村地区、性别、家庭收入和治疗费用。一些研究还强调了实验、以前的卫生服务经验和习惯在塑造家庭选择方面的重要性。本评价超越了众所周知的护理寻求障碍和护理途径的线性模型，表明治疗决策是一个动态过程，其特点是不确定性和争论，同时进行多种和同时的治疗实验，以及对疾病和治疗选择的解释不断变化，家庭决策取决于与各种角色的社会协商，并受到对财务资源的控制的影响。本评价最后提出了研究建议，以解决知识方面的剩余差距。
Cochrane Database Syst Rev. 2021-10-27
Cochrane Database Syst Rev. 2022-10-4
Cochrane Database Syst Rev. 2024-12-12
JBI Database System Rev Implement Rep. 2015-6-12
JBI Database System Rev Implement Rep. 2016-4
Afr J Prim Health Care Fam Med. 2025-7-8
Front Epidemiol. 2025-5-15
BMJ Glob Health. 2025-3-28
Bull World Health Organ. 2024-9-1
Zotero 插件