Aftab Wafa, Shipton Leah, Rabbani Fauziah, Sangrasi Kashif, Perveen Shagufta, Zahidie Aysha, Naeem Imran, Qazi Shamim
Department of Community Health Sciences, The Aga Khan University, Karachi, Stadium Road, P.O Box 3500, Karachi, 74800, Pakistan.
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
BMC Health Serv Res. 2018 Jan 27;18(1):44. doi: 10.1186/s12913-018-2845-z.
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.
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.
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.
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.
The trial is registered with 'Australian New Zealand Clinical Trials Registry'. Registration Number: ACTRN12613001261707 . Registered 18 November 2013.
在儿童腹泻和肺炎治疗设施不足的地区，社区病例管理（CCM）是改善医疗服务可及性的有效方式。在巴基斯坦，通过女性健康工作者项目对这些疾病进行社区病例管理的利用率仍然很低。获取医疗设施方面的挑战依然存在，导致治疗延误和不良后果。评估照料者的知识、了解他们的认知和行为，并认识到这些与儿童腹泻和肺炎就医决策之间的关系，对于实现供需双方行为的协调一致至关重要。
收集家庭照料者的数据，以探索他们对儿童腹泻和肺炎的知识、认知和行为。来自7025名照料者的家庭调查数据、七次焦点小组讨论（FGD）、七次深入访谈（IDI）和20次详细的叙述性访谈数据，用于探索照料者的知识、认知和行为。
家庭调查显示，大多数家庭照料者认识到腹泻的主要体征和症状，如稀便（76%）。较少有人认识到肺炎的体征和症状，如呼吸问题（21%）。很少有照料者（18%）相信女性健康工作者（LHW）治疗儿童腹泻和肺炎的能力。向女性健康工作者寻求治疗的比例仍然微不足道（<1%）。绝大多数照料者更愿意向医生寻求治疗（97%）。75%的照料者向私人医疗服务提供者寻求治疗，45%向公共医疗服务提供者寻求治疗。焦点小组讨论、深入访谈和叙述性访谈表明，护理大多从家庭疗法开始，有时也会使用自行开的药。由于照料者无法识别疾病、使用家庭疗法、经济限制以及社区女性健康工作者服务利用率低，导致治疗延误。由于缺乏信任以及女性健康工作者无法提供药品，照料者不会向她们寻求治疗。如果经济条件允许，照料者认为反应更快的私人医生比公共部门医生更受青睐。经济资源、可利用时间、家庭和社区对家务的支持程度决定了照料者是否、何时以及向谁寻求治疗。
许多儿童没有按时接受推荐的腹泻和肺炎治疗。考虑到照料者的担忧，为女性健康工作者提供充足的药品供应，改善医疗机构层面的护理，可能会改善就医行为并提高儿童健康水平。
该试验已在“澳大利亚新西兰临床试验注册中心”注册。注册号：ACTRN12613001261707 。于2013年11月18日注册。
