Department of Community Medicine, University College Hospital, Ibadan, Nigeria.
Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Pediatr Pulmonol. 2020 Jun;55 Suppl 1:S104-S112. doi: 10.1002/ppul.24620. Epub 2020 Jan 27.
Appropriate and timely care seeking can reduce pneumonia deaths, but are influenced by caregivers and community norms of health and illness. We explore caregiver and community perceptions, and care-seeking experience, of childhood pneumonia, to understand contexts that drive pediatric service uptake in Nigeria.
Community group discussions and qualitative interviews with caregivers in Lagos and Jigawa states were completed between 1 November 2018 and 31 May 2019. Participants were recruited from purposively sampled health facility catchment areas with assistance from facility staff. We used episodic interviews, asking caregivers (Jigawa = 20; Lagos = 15) to recount specific events linked to quests for therapy. Community group discussions (n = 3) used four vignettes from real pneumonia cases to frame a discussion around community priorities for healthcare and community-led activities to improve child survival. Data were analyzed using the framework method.
We found poor knowledge of pneumonia-specific symptoms and risk factors among caregivers and community members, with many attributing pneumonia to cold air exposure. Interviews highlighted that care-seeking decision making involved both husbands and wives, but men often made final decisions. In Lagos, older female relatives also shaped quests for therapy. Cost was a major consideration. In both states, there were accounts of dissatisfaction with health workers' attitudes and a general acceptance of vaccination services.
There is a need for community-based approaches to improve caregiver knowledge and care seeking for under-five children with pneumonia. Messaging should attend to knowledge of symptoms, risk factors, family dynamics, and community responsibilities in healthcare service delivery and utilization.
适当且及时的就医可以降低肺炎的死亡率，但这受到照顾者和社区对健康与疾病的观念和规范的影响。我们探索了照顾者和社区对儿童肺炎的看法和就医经验，以了解在尼日利亚推动儿科服务利用的背景因素。
2018 年 11 月 1 日至 2019 年 5 月 31 日期间，在拉各斯和吉加瓦州进行了社区小组讨论和对照顾者的定性访谈。参与者是从有针对性抽样的卫生机构服务范围内招募的，得到了机构工作人员的协助。我们使用情节访谈，要求照顾者（吉加瓦州=20 人；拉各斯州=15 人）详细描述与寻求治疗相关的具体事件。社区小组讨论（n=3）使用了四个来自真实肺炎病例的情景，围绕社区对医疗保健的优先事项和改善儿童生存的社区主导活动进行了讨论。使用框架方法对数据进行分析。
我们发现照顾者和社区成员对肺炎的具体症状和危险因素知之甚少，许多人将肺炎归因于冷空气暴露。访谈强调，照顾者在做决定时既涉及丈夫也涉及妻子，但男性通常做出最终决定。在拉各斯，年长的女性亲属也影响了治疗的寻求。费用是一个主要考虑因素。在两个州，都有对卫生工作者态度不满和对疫苗接种服务普遍接受的说法。
需要采取基于社区的方法来提高照顾者对 5 岁以下儿童肺炎的认识和就医行为。信息传递应该关注症状、风险因素、家庭动态和社区在医疗服务提供和利用方面的责任。
