title: Interrupting pathways to sepsis: Effectiveness of an intervention to reduce delays in timely care for sick children in rural Bangladesh.
abstract: The time it takes for a child with suspected sepsis to receive care is critical.
  
  
  
  We evaluated care-seeking practices for sick children under 5 years in rural Bangladesh, following interpersonal communication to inform households of newly introduced supports for quality care. Based on the Delays Framework, we assessed length and source of care-seeking delays, use of formal providers, and autonomous decision-making among mothers.
  
  
  
  Using two cross-sectional rounds before and after the 3-year intervention (August 2012 and August 2015), we surveyed 400 mothers of recently sick children in 26 randomly sampled villages from 2 intervention and 2 control subdistricts, using structured questions about delays. Six to ten times during the 18-month intervention period, local workers communicated four key messages to most intervention households in 292 villages: serious symptoms of suspected sepsis in children, a call-in center number for referral advice, a reliable transport hub, and upgrades to the local hospital.
  
  
  
  Compared to baseline, endline results demonstrated a significant difference in the total delay between the onset of child's illness and seeking external care, with intervention families having shorter delays. Over 90% of mothers informed someone in the family, mainly the husband, about the sick child before acting to seek care. Delays due to transportation and receiving provider care were short and not different. Using a benchmark of seeking external care within 24 h of onset, only 14.14% of intervention households and 13.40% of control households were "timely" in seeking care. Approximately 78% of parents, similar for the two groups, sought care from a non-formal practitioner (the village doctor).
  
  
  
  The results demonstrate that the delay in deciding to seek external care is most serious, and that communication strategies at the community level are necessary to increase the uptake of improved health services.
authors.affiliation: Department of Psychology, McGill University, Canada. Electronic address: frances.aboud@mcgill.ca.
authors.forename: Frances E
authors.initials: FE
authors.lastname: Aboud
authors.affiliation: International Centre for Diarrheal Disease Research, Bangladesh.
authors.forename: Ehsanur
authors.initials: E
authors.lastname: Rahman
authors.affiliation: School of Population and Public Health, University of British Columbia, Canada.
authors.forename: Rosemin
authors.initials: R
authors.lastname: Kassam
authors.affiliation: International Centre for Diarrheal Disease Research, Bangladesh.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Khan
authors.affiliation: International Centre for Diarrheal Disease Research, Bangladesh.
authors.forename: Nabeel Ashraf
authors.initials: NA
authors.lastname: Ali
authors.affiliation: International Centre for Diarrheal Disease Research, Bangladesh.
authors.forename: Fahmida
authors.initials: F
authors.lastname: Taleb
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001459:Bangladesh; D000067576:Child Health / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D015277:Hotlines / Q000706:statistics & numerical data; D006801:Humans; D006920:Hygiene / Q000592:standards; D008297:Male; D010342:Patient Acceptance of Health Care; D026684:Personal Autonomy; D012424:Rural Population / Q000706:statistics & numerical data; D018805:Sepsis / Q000517:prevention & control* / Q000628:therapy; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Bangladesh; Care seeking; Community engagement; Delays framework; Evaluation; Sepsis