title: Sociocultural and structural factors contributing to delays in treatment for children with severe malaria: a qualitative study in southwestern Uganda.
abstract: Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural factors were 1) interviewee's distinctions of "traditional" versus "hospital" illnesses, which were mutually exclusive and 2) generational conflict, where deference to one's elders, who recommended traditional medicine, was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness, debt, and poverty consistent with a model of structural violence. Our findings inform a number of potential interventions that could alleviate the burden of this preventable, but often fatal, illness. Such interventions could be beneficial in similarly endemic, low-resource settings.
authors: Radhika
authors: R
authors: Sundararajan
authors: Juliet
authors: J
authors: Mwanga-Amumpaire
authors: Harriet
authors: H
authors: Adrama
authors: Jackline
authors: J
authors: Tumuhairwe
authors: Sheilla
authors: S
authors: Mbabazi
authors: Kenneth
authors: K
authors: Mworozi
authors: Ryan
authors: R
authors: Carroll
authors: David
authors: D
authors: Bangsberg
authors: Yap
authors: Y
authors: Boum
authors: Norma C
authors: NC
authors: Ware
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D003469:Culture; D057210:Delayed Diagnosis; D005191:Family Characteristics; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008519:Medicine, Traditional; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011203:Poverty; D036301:Qualitative Research; D012959:Socioeconomic Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000962:Antimalarials