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Care-seeking patterns amongst suspected paediatric pneumonia deaths in rural Malawi [version 1; peer review: 2 approved]: a mixed methods study

King, C; Banda, M; Bar-Zeev, N; Beard, J; French, N; Makwenda, C; McCollum, E; ... Colbourn, T; + view all (2020) Care-seeking patterns amongst suspected paediatric pneumonia deaths in rural Malawi [version 1; peer review: 2 approved]: a mixed methods study. Gates Open Research , 4 , Article 178. 10.12688/gatesopenres.13208.1. Green open access

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Abstract

Background: Pneumonia remains a leading cause of paediatric deaths. To understand contextual challenges in care pathways, we explored patterns in care-seeking amongst children who died of pneumonia in Malawi. / Methods: We conducted a mixed-methods analysis of verbal autopsies (VA) amongst deaths in children aged 1-59 months from 10/2011 to 06/2016 in Mchinji district, Malawi. Suspected pneumonia deaths were defined as: 1. caregiver reported cough and fast breathing in the 2-weeks prior to death; or, 2. the caregiver specifically stated the child died of pneumonia; or 3. cause of death assigned as ‘acute respiratory infection’ using InterVA-4. Data were extracted from free-text narratives based on domains in the ‘Pathways to Survival’ framework, and described using proportions. Qualitative analysis used a framework approach, with pre-specified themes. / Results: We analysed 171 suspected pneumonia deaths. In total, 86% of children were taken to a healthcare facility during their final illness episode, and 44% sought care more than once. Of children who went to hospital (n=119), 70% were admitted, and 25% received oxygen. Half of the children died within a healthcare setting (43% hospital, 5% health centre and 2% private clinics), 64 (37%) at home, and 22 (13%) in transit. Challenges in delayed care, transport and quality of care (including oxygen), were reported. / Conclusions: Healthcare was frequently sought for children who died of suspected pneumonia, however several missed opportunities for care were seen. Sustained investment in timely appropriate care seeking, quick transportation to hospital and improved case management at all levels of the system is needed.

Type: Article
Title: Care-seeking patterns amongst suspected paediatric pneumonia deaths in rural Malawi [version 1; peer review: 2 approved]: a mixed methods study
Open access status: An open access version is available from UCL Discovery
DOI: 10.12688/gatesopenres.13208.1
Publisher version: https://doi.org/10.12688/gatesopenres.13208.1
Language: English
Additional information: Copyright © 2020 King C et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: mortality, pneumonia, child, sub-Saharan Africa, pathways to survival
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10118160
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